Service Learning Journals

Jennifer Mynhier
Figure 1: Outside the Xenacoj Clinic
Journal One
Agency: International Volunteer HQ/Mximo Nivel
January, 6
th
2014
Volunteer Nursing Student

When I attended the Spring Nursing Fair my first semester in the nursing program, and
we got to look at all of the service learning presentations, I knew then that I wanted to go to
Guatemala. The previous students had gone through the website International Volunteer HQ
(IVHQ) which is an agency that offers many different types of volunteer experiences and
opportunities. There are many locations to choose from, and many types of volunteer work that
they offer. A total of eight nursing students decided to go on this trip. Once we booked through
IVHQ they placed us with a local volunteer company in Antigua, Guatemala called Mximo
Nivel. They placed us with our host family, Casa Matilde Snchez, which provided all of our
meals and housing. They also placed us with the healthcare facility we would be volunteering at.
Among the eight of us, we were split into three separate groups, two of our groups went to rural
health clinics, and one of the groups went to a nursing home.
My group went to a rural health clinic in Santo Domingo Xenacoj. In order to get there,
we had to walk to our bus stop, which was about fifteen minutes, take two separate buses and
then a van. It took us over an
hour every day. Luckily, it is
the norm in Guatemalan
culture to be late to everything,
as we were not always able to
rely on the buses to be on time!
The first day, we were taken to
Service Learning Journals
Jennifer Mynhier
our clinic by a worker from Mximo, Victor. He showed us which buses to take, which stops to
get off at, and then how to get back home.
Once we arrived at the clinic, we were given a tour. Our clinic treats mostly women and
children. It is a free clinic, so the majority are in poverty. The people that come in are there for
vaccinations, checkups, or when they are sick. Within the clinic, they have a couple triage rooms,
a vaccination clinic, an emergency room, a room for sterilization and nebulizer treatments, a
small pharmacy, and a few examination rooms. We got a tour around the clinic, met some of the
nurses, and told what we would be doing there for the rest of the week. The week we were there,
the only doctor they have was gone for the week, so the clinic was being run only by the nurses
and nursing assistants.
The first day was mostly an orientation day, so we got our tour, and then observed some
of the different things they do in the clinic, so we did not do much patient care ourselves. It was,
however, a good way to be introduced to the clinic and the workers, and what expectations they
had for us. We did run into some difficulty throughout the week because of the language barrier.
The first day, we had Victor with us, who was able to translate everything perfectly, so it was
nice to have him there to help us get more comfortable and know exactly what to expect.
I have never been so far out of our country and my comfort zone, so my goal for this day
was to become more comfortable with my surroundings and find out what would be expected of
me throughout my experience there. This was met by this orientation day. I did not feel too
uncomfortable, and having someone there to translate everything was very helpful with this.
One of the outcomes of the School of Nursing is professionalism. I feel that we showed
up that first day on time, dressed in appropriate scrubs, and with a professional attitude and
willingness to learn, help out, and grow as a future nurse.
Service Learning Journals
Jennifer Mynhier
Figure 2: Preparing to give an IM injection
Journal Two
Agency: International Volunteer HQ/Mximo Nivel
January, 7
th
2014
Volunteer Nursing Student

I was very excited to get started on my first official day past orientation. We walked to
the bus stop, took our buses and our van and headed for Santo Domingo. When we got there, we
were able to all help triaging patients. Each patient or family would come into triage, everyone
got weighed. The adults got their blood pressure taken and the children got their temperature
taken. There is a high population of tuberculosis, so everyone was asked if they had a cough, and
if the cough lasted longer than seven days. Once they got triaged, everyone waited in a large
common area.
There were many reasons that the patients would be coming into the clinic. Many of the
patients were there to have injections, to be treated when they are sick, or just to have a check-
up. After everyone got triaged, they would be taken one-by-one to be treated however was fit.
We were able to give a lot of injections to the people. The injections were mostly vitamins,
usually to treat a deficiency, a majority of these patients are very poor, and so their nutritional
needs are not always being met. Some of the injections were also antibiotics for those that were
sick. All of the injections we gave were
given intramuscular. As expected, many of
the techniques and materials used, are not
the norm of what we use here in the United
States. Usually the injections were given in
the dorsogluteal site, but some of the
patients requested them in the deltoid
Service Learning Journals
Jennifer Mynhier
muscle. Most of the injections given came in glass vials, we were sometimes told to mix them
with normal saline, but not always. They do not have filter needles in the clinic, so we were
unable to use those with the glass vials. The needles we used to give the injections were also
larger than what we would use here, 18-19 gauge, which is much more uncomfortable for the
patients. Many of these patients came in several days in a row to get their vitamin injections. One
of the patients came in for her injection three days in a row, hers was unique from the other
injections. It was some type of multivitamin, and the vitamin itself was a dark black liquid, it was
very strange.
In addition to antibiotics and vitamins, many of the patients are there for vaccinations.
The common vaccinations in that area of Guatemala include diphtheria, tetanus, pertussis, Hib,
hepatitis B, polio, MMR, rotavirus, pneumococcal, and vitamin A supplementation. Rather than
having individually wrapped alcohol prep pads like we typically see commonly here in our
hospitals, they have a metal jar filled with alcohol soaked cotton balls. Although I have seen this
at some of the doctors offices here in the United States. I think that it would be a much cheaper
method to use, and seems like it would be just as clean. When you see things like this, it opens
your eyes up to why our healthcare system is so expensive. Many things that we do that are more
expensive, I know are appropriate and evidence-based, such as our use of filter needles to
prevent injury from the glass vials, but money could also be saved in other ways without risking
safety and quality.
The majority of the day after triage was spent giving injections. We also went to lunch at
a delicious street vendor near the clinic. At the end of the day, we took our van and two buses
back to our host family in Antigua.

Service Learning Journals
Jennifer Mynhier
Figure 3: Emergency Room supplies
Journal Three
Agency: International Volunteer HQ/Mximo Nivel
January, 8
th
2014
Volunteer Nursing Student

For our third day in the clinic, we arrived and assisted with triage as we did the day
before. We took blood pressures, height and weight, and asked some of the generic questions
required. Once everyone got triaged, we were able to give more injections of vitamins, vaccines,
and antibiotics. I got to spend some time in the emergency room assisting with people that had a
wide variety of symptoms including cough, difficulty breathing, fever, and lacerations. Any
patient we got with a cough, we had to make sure the cough had not lasted longer than seven
days. If it had, there is a good
chance that it could be
tuberculosis. I assisted a patient
getting a nebulizing treatment
for her difficulty breathing. The
pediatric patients that had a
fever, we would take the
temperature, sometimes rectally
or under the armpit. These patients usually got Tylenol to help bring down the fever. I helped
getting two patients with lacerations cleaned up and bandaged. Some of the patients received
antibiotics for their illness, either in injections or medications. I took some of the patients over to
the pharmacy to get the medications or injections and then administered the injections.
Service Learning Journals
Jennifer Mynhier
It was very interesting to see the differences in the care given based on their lack of
medical supplies. They do not use prepackaged gauze or scissors or anything like we do. With
the limited funding and supplies that they have, they are required to cut and sterilize their own
gauze and they sterilize their own tools. They dont really used Band-Aids because they are on
short supply. It is more common to cover with gauze and then tape it.
The first day we were there, the nurses asked if we had another sphygmomanometer to
replace one of the ones they had, because it did not work very well anymore, as it was very old
and worn. We did not have one, so we talked to Mximo about it, and with funding that they
have on hand from donations and the money they make from volunteers like us, they were able
to replace the one they had and also supplied them with one specifically for pediatrics. This was
great that we were able to help make that happen for them. It is a good form of advocating for
our patients, by making sure equipment used is up to standards.
I attempted to meet my own goals of the day by being more proactive. I did not always
know what was being said word for word because of the language barrier, but I did not let that
stop me from doing what I needed to do to help out. There was a nurse there that was able to
speak a little bit of English, and one of my classmates spoke more Spanish than me, so that
helped. We also had a Spanish and English dictionary on hand and a phrase book for medical
terms to help us as well.
One of the goals of the nursing program is the healthcare environment. I did what I could
this day to advocate for the clinic and the patients that are treated there by helping to locate new
supplies and help to sterilized and prepare some of the items needed for care of the patients.