Download Proposal for Medical Student Internship at Casa Materna, Matagalpa, Nicaragua Background

Proposal for Medical Student Internship at
Casa Materna, Matagalpa, Nicaragua
Background
Nicaragua is presently the second poorest country in Latin America, second only to Haiti.
Nicaragua has a difficult history of war, poverty, and exceedingly high rates of maternal and
infant mortality. In the 1980’s the Casa Materna was conceived of as part of the effort to alter
this health care crisis situation. In 1990 the Cuban consulate was purchased to house the Casa
with a grant from Spain’s “Instituto de la Mujer.” In 1991 the Casa Materna was established and
the first child was born—she and her mother survived. The intention of the program was to
identify women who have high-risk pregnancies and provide them with the appropriate medical
care, as well as health education in order to reduce the risks of future pregnancies. It was
organized as a unique model incorporating community medicine and grass roots organizing
techniques. Since 1991 they have served over 3,700 mothers who faced a high likelihood of
severe complications, with only the loss of a single mother’s life.
The issues of high-risk pregnancy and health education are handled with extremely
limited resources. These resources may be further limited by the devastating damage to the bean
crops this year because of the El Niño weather patterns. Hopefully this will not make every
pregnancy a high risk one. However, the creativity, resourcefulness, and experience of the health
care workers involved in this effort will give me, as a fourth year medical student, a rich
educational opportunity.
The Proposed Internship
I propose to spend 6 months at the Casa Materna in Matagalpa, Nicaragua, and the
associated health care institutions under the mentorship of the practicing physician of the Casa
Materna, Dr. Maura Mareina, and the Casa Materna coordinator, Kitty Madden. As such I will
participate in three ways: 1. I would expect to be involved directly in patient care under the
supervision of the physician at the Casa Materna; 2. I propose to provide services as a health
educator who will bring an educational program in an area which we have identified as an area
of need, such as an understanding about the health benefits to mother and child of pregnancy
spacing, oral rehydration and infant mortality, and issues of domestic violence and associated
patterns of violent behaviors directed at the children; and 3. Research evaluating the work of the
program.
Clinical Training Experience
By the completion of the internship I should have a greater understanding of high-risk
pregnancies, the risk factors contributing to this in this area of Nicaragua, how they are
identified, managed, and possibly prevented. I should gain knowledge of what health education
is useful in this environment and what sorts of assessments and interventions are being made
prenatally and postnatally. I should have improved my skills in providing care during labor and
delivery, including natural vaginal deliveries and Caesarian deliveries, fluid management, and
the use of medications available in that setting.
Health Education
In order to provide a meaningful educational intervention, I will work with Margaret
Freda, of Weiler Hospital, a health educator with a great deal of experience with such programs,
in developing a program, utilizing successfully prepared materials. I will also be working with
Dr. Cynthia Chazotte, also of Weiler Hospital, who will be my principal advisor in NYC before,
during and after my stay in the Casa Materna.
Research
The research component will be carried out with the help of Dr. Cynthia Chazotte and Dr.
Maura Mareina, and Kitty Madden of the Casa Materna. They have been collecting data about
the Casa and are very interested in a chance to assess their work. The assessment should help
them make decisions to serve their population better and to inform others about their work. It is
possible that the success of this program, and the work they have done to develop such a
program could be helpful to women in other parts of Nicaragua, Latin America, or even New
York. A good assessment of their work and the publishing of the data may inform others of the
possibilities this represents. I will have time when I return from Nicaragua to work with Dr.
Chazotte and the epidemiologists on the staff of the Department of Ob/Gyn to complete work on
the research projects as I will be graduating with the class of 2000.
Language Preparation
At this point my Spanish language skills are not proficient enough to do the internship in
Matagalpa. Because these skills are both necessary in order to do this clinical and research
project and because they are important in order to practice in many parts of the USA including
NYC, I believe it is necessary for me to achieve proficiency in Spanish. I am also very interested
in doing international medicine as a part of my career and would like to develop an ongoing
relationship with Central America. This strengthens my motivation to become fluent in Spanish.
As such I would like to attend and eight week language program in Guatemala before beginning
at the Casa Materna.
Personal Qualifications
I am a third year medical student interested in Ob/Gyn, and extremely interested in
continuing to work internationally. I am also a licensed massage therapist in practice for nine
years. I have studied herbal medicine in New York City and performed as a dancer for a number
of years. I have done research and participated in the Human Rights Clinic in NYC, which sees
patients interested in seeking asylum because they were victims of torture in their countries of
origin. I also conceived of, organized, and attended two symposia on the recognition of violence,
and intervention in the lives of our patients, and have trained for and worked for a rape crisis
hotline. I would be able to contribute these skills as well as the medical skills acquired during the
first 3 years of my medical school training. I expect to have completed all of my third year
required clerkships as well as electives in infectious diseases and a subinternship in Ob/Gyn
before going to Nicaragua.
Budget Proposal for Internship at the Casa Materna, Matagalpa, Nicaragua
Airfare to Guatemala from NYC,
Guatemala to Nicaragua, Nicaragua to NYC
$1,000
Travel to and from the airports
$ 140
Room, board and Spanish classes in Guatemala
$250/week x 8
$2,000
Room & board in Nicaragua
$500/month x 6
$3,000
Travel in Nicaragua for outreach and education
$50/month x 6
$ 300
Communication—telephone/e-mail to USA
$60/month x 8
$ 480
Research—Xeroxing, library fees, misc.
$40/month x 6
$ 240
Gifts for hosts, contacts in Nicaragua
$ 200
Personal expenses/unexpected costs
$200/month x 8
$1,600
Total
$9,060