Medical Fellows: Pre-Med/Global Health Program in Guatemala

My 13 months with GPSA taught me so much about myself and the world that I live in. I grew immensely and learned about Global Health through real world experience all while learning/practicing my Spanish.

The staff at GPSA is extremely supportive and really took any requests or suggestions to heart. They are all super caring people who want the best for both the program and Medical Fellows.

My host family was absolutely amazing. I lived in an indigenous community with a large family that included 10 grandchildren all under the age of 10 years. My relationship with my host family is something I will cherish my whole life and already can not wait to return to visit them (or maybe even for them to visit me).

My social scene consisted mostly of other Medical Fellows, Peace Corps Volunteers and Guatemalan natives. We would either meet up and spend time together in Xela or go on weekend trips (often times hiking and camping). However, Medical Fellows definitely have a lot of down time so I would recommend bringing books or other materials for hobbies (ie paints, yarns, tennis racket, soccer ball etc.)

In terms of work, the Medical Fellow will spend time working with a local, government-run clinic in their town. This is where initiative from the part of the Medical Fellow is really imperative. GPSA with introduce you to clinic staff and your main point of contact will be the clinic's Rural Health Technician. Your work will vary day to day- sometimes it will be taking blood pressure or height and weight of babies and other days it will be assisting with hygiene education in local schools or assisting with rural vaccination campaigns. Sometimes, you will not have a job unless you make one for yourself and projects will only get done if initiate them. Apart from this, Medical Fellows work week-long programs with high-school students. These are much more fast-paced, and you will be expected to live with, and mentor and teach these students.

Overall, I would definitely recommend being a Medical Fellow with GPSA. I was able to make connections from people all over the world as well as travel to Belize and West Virginia. My Spanish greatly improved with the Spanish lessons provided and of course speaking it with my host family and at work everyday.

THE BAD

The GPSA medical fellow program is relatively new (within the last 5 years), and it suffers certain organization growing pains that are natural to any new organization. In particular, difficulties often exist with the rate at which serious complaints about the program are received and handled. This is mostly due to the structure of the organization and the physical distance in between those on the ground and key decision makers. For example, unlike most volunteer organizations in which volunteers are geographically located in the same place as their volunteer coordinators, medical fellows are located in rural pueblos and their coordinators are located in the nearby city of Xela. Because of this, when a medical fellow does have a difficulty with something in the community, it can sometimes be difficult for those difficulties to be communicated effectively and resolved quickly.

Problems also exist given the business model of the organization. The business model of GPSA is entirely oriented around the programs it sponsors for high school students, and the role the medical fellow have in that model is to act as a chaperone during those programs. The actual volunteer work medical fellows do on the ground between programs is almost entirely separate from this model. As such, the interest of programs almost always dominates the interest of the volunteer experience. This prioritization is mostly clearly apparent by the way in which medical fellows are consistently pulled away from their work-sites to participate in programs, often for weeks a time, making it difficult to have a project that is consistently represented on the ground. As GPSA continues to add programs to its calendar--something it is highly incentivized to do given its business model--there is not something obvious thing stopping most of the time spent by medical fellows being allocated to programs and very little on actual volunteer work. As such, if one is interested in being a medical fellow, one should be as directed as possible at the very beginning to ask what percent of one's time will be spent in their work-site as opposed to on a program and perhaps even more importantly when that time will be scheduled (e.g. will it be for one large chunk at a time or more sporadic), which has a lot of influence on the type and scale of project that can be conducted.

A few comments could be made about the actual volunteer experience. As set up, the volunteer experience is broken up into three processes: (1) the process of performing a community needs assessment, (2) the process of preparing your project proposal, (3) the process of carrying out your project. Throughout these processes (especially the first one), the medical fellow is encouraged to build relationships at the clinic or nearby institutions so as to inform what their project may ultimately be. This can be a very challenging process depending on the community the medical fellow finds themselves in and their confidence with the culture and language. Indeed, little cultural training is given at the beginning of the program, leaving the situation such that you as a medical fellow are a foreign student who would like to help, but knows very little of the culture and language and sometimes is not very welcomed in the work setting because of that. However, two points could be made as a response to this criticism: (1) first of all, the particular cultures of various pueblos are very different, and it would be difficult to perfectly prepare medical fellows for the nuances of their specific communities; (2) secondly, there have been a number of medical fellows who have nevertheless been very warmly received into their communities and immediately connected with individual stakeholders in the community who wish to assist them on potential projects. But this second point is not guaranteed, and I don't believe GPSA does a great job ensuring the probability that this warm welcoming is high. Most of GPSAs institutional interaction in Guatemala is through the ministry of health, an organization located in Xela which has little direct contact with the individual Centro de Saluds in the work-sites of medical fellows. This, I believe, creates one layer of institutional barrier between GPSA and local knowledge of the needs of those work-sites. GPSA should work to define relationships with the community stakeholders such as the municipality so that the community doesn’t look at the volunteers as outsiders because they are already familiar with our organization. To be sure, this process may be happening bit-by-bit as generations of medical fellows work in the same community, but during that process some medical fellows are inevitably left as “guinea pigs” to develop all those relationships for the very first time. In short, sometimes there are obvious projects for medical fellows to begin working on spearheaded by local communities leaders, and other times the onus is much more on the individual medical fellow to create those projects from scratch, hoping that something reasonable and meaningful can manifest itself in the time given.

And, moreover, while there are things such as a community needs assessment and project proposal set in place to guide the process of getting to know one’s community and developing a meaningful project, the stringency with which these reports need to be done is very minimal; there is very little oversight. As such, the research component is largely something that is good as you want to make it. Indeed, the GPSA volunteer experience as a whole is largely what you make (as opposed to, for example, a lot of top-down organizational pressure), and the actual projects that medical fellows carry out vary substantially. In a good sense, this reflects the variety of interests that medical fellows have and how they pair those interests with specific needs in the community. On the other hand, it reflects the lack of programmatic infrastructure that GPSA has in its partner communities. This could all be summarized as following: GPSA is a new organization with little organizational infrastructure making the quality of the volunteer experience highly variable and highly dependent on the spontaneous relationships formed within the community. However, to be sure, as the organization grows and learns from its failures and builds stronger (more sustainable) partnerships with its communities, there is strong reason to believe that the volunteer experience will be much more consistently great.

THE GOOD

The best part of the GPSA, in my opinion, has been the elements of cultural exchange (despite the minimal cultural training), the opportunities to explore the country, and the personal growth that necessarily comes when one is thrown out of their comfort zone so radically. It is truly an incredible thing to become part of another family of a different culture--to laugh with them, to go on adventures with them, to share meals with them. Without getting too pithy, as a medical fellow you will learn so much about both the complexity and beauty of human culture, finally being forced to experience it as a foreigner. Secondly, Guatemala is an incredibly beautiful country--lush mountainsides punctuated by hot springs and volcanic lakes--making the opportunities to explore and experience that beauty unquenchable during your year as a medical fellow. I will never forget some of the sights I've seen from the tops of Guatemalan Volcanoes--they almost single-handedly made the whole year worth it.

I said earlier that the volunteer experience can be incredibly varied. This, of course, leaves room for truly wonderful experiences in which the project developed is something the Medical Fellow is passionate about, it responds to a real need in the community, and specific members of the community are enthusiastic about helping the medical fellow accomplish said project. While I don't think that all medical fellows can say that that ideal describes 100% of their volunteer experience, I don't think there has been a Medical Fellow that would say they haven't at least done a few activities in which all three of those factors aligned.

GPSA is also generous insofar as they provide you with Spanish classes during your first few months on site. While my lack of Spanish going into the program was certainly a handicap during the first many months, I am also most satisfied with the amount my Spanish has grown since coming the country and it will likely be the most "professionally applicable" thing I take away from my time.

Moreover, while perhaps born out of a need created by a lack of institutional relationships, the task of the medical fellows personally creating partnerships with community stakeholders could be considered a positive. Not only does it help you submerge with your community because community members then see you’re willing to help and put in the work, but it also helps develop your Spanish by forcing you to have such conversations. Additionally, it gives you the opportunity to work with other organizations within the community that GPSA as an institution does not often consider (for instance, various groups in the municipality that don’t directly focus on health in the same manner as the Centro de Salud does).

Finally, while organizational difficulties exist, the actual staff of GPSA are incredibly kind and caring individuals who I do believe are doing their best to improve a young organization. A medical fellow should hardly need to worry that their complaints and difficulties are not being heard or understood, even if it nevertheless takes some time for them to be resolved.

The GPSA program provided me a lot of insight to what else is out there in the world! I had never been immersed in a different culture in the way that GPSA sets it up for each medical fellow to experience. Socially, the experience is what you make it. There are social scenes for all types of personalities so it's up to you to explore your options. Professionally, the work scene was totally different than what I was used to. The people here are way more relaxed and easy-going than in the states. At first, to be honest, it was a bit frustrating because I felt like I wasn't getting work done. Yet, once you realize that this isn't your home and things don't work the same way so you can't compare cultures because they're totally different- things will get easier for you. The clinical work can become repetitive and at times boring so I suggest adding in projects with local community workers. There are always health projects going on you just have to search for them by finding health commissions in your community.

In all, the team at GPSA is very flexible and reasonable to meet your needs. There are here to make sure not only the community you work in is being served but also that you're taking something positive out of the experience as well. If you are not having the experience you set out to have- make it happen yourself. Make your time here count!

I did the GPSA Medical Fellow program this past year (May 2017-June 2018). I lived in a rural, indigenous town called Zunil, about 30 minutes outside of Xela, Guatemala. I decided to take a gap year before applying to medical school in order to gain more clinical experience, step away from the books, explore my passion for global health, and grow/mature. I was immediately intrigued by GPSA because it would allow me to live (with a host family) in a town and work in the health center as well as give me the opportunity to learn more Spanish. The program also was a year long which I believe is an adequate amount of time to really learn (especially the language) and make an impact.

Working in the health clinic and health posts gave me the opportunity to provide services that truly met a need in the community. Much of the work I did was related to glucose testing which wasn't normally available. I learned the challenges and skills for developing and implementing successful interventions. I also gained great experience in patient contact. It was an amazing feeling to integrate into a community and gain the trust of patients. Being a member of the health team exposed me to community health/outreach and the efforts put forth to increase healthcare access.

Living in Zunil was nothing short of amazing. I loved having the opportunity to live in an indigenous town with an amazing family. My host family became my real family and I will be connected to them for the rest of my life. Living in the area where I worked allowed me to understand the lifestyle as well as allowed everyone to become familiar with me. There is such value in building rapport and transitioning from outsider to community member.

GPSA service-learning programs gave me the opportunity to build mentorship skills and work with/influence the next generation. Also the program locations allowed me to experience community health in West Virginia and Belize. Being able to have a cross-cultural, multi-country experience was truly unique. The programs were one of the more demanding/challenging parts of the medical fellow position, but nevertheless rewarding.

Guatemala is such a beautiful country and an amazing place to be. The medical fellow position truly has a lot to offer as long as you are willing to go out of your comfort zone, be independent, be flexible, and learn! I grew so much from being a medical fellow and gained experiences that will greatly benefit me as a doctor and in life.

Hi there! I was a Medical Fellow with GPSA from May 2017 - June 2018. I joined the organization after graduating from Duke University because I wanted to explore my interests in global and public health before applying to medical school. I was placed in a rural town in Guatemala, where I worked with the local government health clinic on public health projects. I also served as a team leader for groups of high school students who came on GPSA programs.

My favorite part about this program was living with my host family. I truly view them as my family now and I always will. Living with a host family helped integrate me into the community, accelerated my learning of Spanish, and gave me a a place to call home for the year.

Working with the clinic was a challenging and rewarding experience. I learned so much about how to develop projects and how to work in a team with a diverse group of people. It was also fascinating to be part of a system that puts so much effort on community projects and education in order to improve public health. This aspect of the job requires a strong ability to work independently!

I also loved loved loved working as a team leader on programs in Guatemala and Belize. These programs are FUN. Many of the high school students I led were inspiring and amazing young people, and it was a privilege to be their mentor and to help guide them during such an important stage of their lives.

Overall I would definitely recommend this program! I grew so much as a person, gained many valuable skills, had some wonderful experiences, and made some really good friends along the way :)