Patient intake at a small medical clinic in a remote area of a Third World country can be difficult, especially when you don't speak the native language.
"A lot of times you just find a common ground," said Jonathan Eyestone, a certified nursing assistant at Billings Clinic. "I knew a few key terms in Spanish. But there was lots of gesturing, lots of pointing. We made do."
Eyestone, then a student with the Billings campus of the Montana State University nursing program, was one of 15 nursing students who traveled to the Dominican Republic in November to help set up and run rural health clinics.
The opportunity was organized by the Timmy Global Health program, an Indiana-based non-governmental organization (NGO) that pairs medical teams with international organizations to build health and development services.
The program brought the students, a pair of MSU faculty members and a handful of medical professionals -- four St. Vincent Healthcare physicians, a St. Vincent lactation consultant, a nurse from Billings Clinic and a pharmacist from Connecticut -- together with Banelino, a fair-trade banana cooperative near the northwestern Dominican city of Monte Cristi, a city of about 17,000 people near the Haitian border.
Banelino oversees about 400 small banana producers and all its workers were eligible to receive care from the team.
Beth Ragbourn, another Billings Clinic CNA who was a student in the program, said they spent most of the two weeks traveling to outlying communities, called "bateys," of 200 to 400 people.
"They're very isolated," she said. "For many of them, there's no running water, no electricity."
Ragbourn and Eyestone both graduated from the MSU nursing program in December and are now employed by Billings Clinic.
Over the weeks, they set up shop in five communities and saw a total of 488 patients.
For the students, most of the focus was on primary care, taking basic vital signs and staffing the clinics from the many patients.
In such a poor and rural area -- far away from the Dominican Republic's tourist-friendly eastern beaches -- the students and medical professionals faced myriad problems.
Dengue fever, a viral disease spread by mosquitoes that can lead to high fevers, aches and fatigue, was the most common problem people brought up, Eyestone and Ragbourn said.
Clinic workers also saw diabetes, respiratory problems and anemia. They also focused on sanitation, disease prevention and basic education.
There were also a few surprises. Some in the Dominican Republic embrace spiritual and religious beliefs that dictate and, in some cases, limit what kind of medical treatment they can receive.
Eyestone said that, with the help of a translator, they simply had to work with what they were given in those cases.
"A lot of times you have to just present what you have," he said. "You don't force it on them. You tell them what you can do and they have to decide."
The group also learned about a hot-button political issue there: illegal immigration. The Dominican Republic shares an island with Haiti and many of the workers in the Monte Cristi region came from Haiti illegally.
"It's not just a poverty issue," said Martha Arguelles, a clinical associate professor at MSU College of Nursing and International Service Learning Program coordinator, who helped organize the trip for the students. "The Haitians who work there as migrant workers in the Domincan Republic are really outcasts. They have no citizenship, no papers. We wanted (the students) to talk about how it influenced people."
Ragbourn said the clinics' open-door policy helped them treat many of those workers.
"Anybody who works (for Banelino) automatically gets cared for," she said. "Anybody who's part of it can get some help."
Arguelles said she's been organizing such overseas trips for second-semester senior nursing students for several years. The students must pay for the trip themselves -- about $2,400 each for the Dominican trip -- but she arranged the work as part of a credited class so they can use student financial aid.
The trip is important, she said, because it opens them up to different health practices and problems they might not see in Montana, as well as exposing them to new cultures and ideas.
"They helped staff the clinics while the providers saw the patients, but just as important were the discussions that we had with the students on the differences in health delivery," she said. "Just every day, all day, they were up to their elbows, working hard to see what this job was like. It made for the students having a very well-rounded experience."
Eyestone said seeing the people's reaction to care from the team made the trip worth it.
"They were extremely grateful for any help you can give," he said.
Both he and Ragbourn said they'd like to go back if possible, although their demanding careers may keep that from happening anytime soon.
"It's just a great experience," Ragbourn said. "Everybody should do it."