Oral and Perioral Manifestations of the Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (AIDS)

Background

Acquired Immunodeficiency Syndrome (AIDS) is a disease caused by retroviruses—the Human Immunodeficiency Virus (HIV). It’s mainly characterized by extreme immunosuppression associated with opportunistic infections, malignancies, wasting, and central nervous system (CNS) degeneration. “The Human Immunodeficiency Virus directly infects lymphocytes and, in particular, depresses the number of T-helper (CD4+) cells and reverses the ratio of helper to suppressor (CD8) lymphocytes” (Cawson, Binnie & Eveson, 1988). There are approximately 36.9 million people currently living with HIV/AIDS. Two forms of the virus have been identified: HIV type 1 (HIV-1) and HIV type 2 (HIV-2). HIV-1 is responsible for most of the infections worldwide and HIV-2 is endemic to many countries primarily in West Africa. The morbidity rates of AIDS-related deaths have been on the decline since the 1990’s, largely in part to the continual improvement of drug therapies and education. In fact, it is now considered a chronic illness.

Route of Transmission

There are various possible routes for transmission including sexual transmission, transmission via needles or from mother to fetus/child. HIV can reside in semen and vaginal fluids, and these fluids can transmit the virus onto mucous membranes of another person. Needles, syringes, and other drug injection paraphernalia are common because they increase the risk for blood-to-blood contacts. Blood donations are now screened for the virus, so blood transfusion recipients are no longer at risk. For children infected with HIV, the mode of transmission is most often directly from the mother to the infant. The virus can be transmitted during pregnancy, birth or while breastfeeding. HIV, however, is not spread via saliva or casual contact.

It’s important to consider that a patient infected with HIV is infectious even in the absence of symptoms. Seroconversion is the term used when an infected person’s blood converts from being negative for HIV antibodies to being positive. Seroconversion usually occurs within 1 to 3 months after exposure but can take up to 6 months. The time between infection and seroconversion is called the window period. Consequently, blood collection centers must screen potential donors to identify those with high risk behaviors who are potentially within this particular window period.

The Phases of HIV Progression

There are three distinct phases in the progression of HIV which occur over a 5-14 year period; the primary infection phase, the chronic asymptomatic (latent) phase and the overt phase. The primary phase is an acute illness stage similar to acute mononucleosis. This phase includes signs and symptoms such as fever, fatigue, headache, pharyngitis, night sweats, oral or genital ulcers and gastrointestinal problems. The latent phase is characterized by a period in which there are few signs or symptoms of the illness. Some patients may present with swollen or sore lymph nodes in two or more locations, not including the groin. The length of the latent phase is averaged at ~10 years. Patients who have entered the overt phase develop AIDS and the risk for opportunistic infections increase significantly.

Manifestations and Features of HIV/AIDS

Other manifestations include, but are not limited to rapidly progressive periodontitis, Addisonian pigmentation, angular cheilitis, herpes simplex or zoster, parotitis, myobacterial ulcers, facial palsy, trigeminal neuropathy and major aphthae.

Treatment

Candidosis: The Centers for Disease Control and Prevention has published guidelines for treatment of oropharyngeal candidosis (OPC) in patient with HIV (December 2004). Their guidelines are divided by age group; adults and adolescents vs. children and infants.

Recommended treatment of OPC in adults and adolescents:

Fluconazole 100 mg PO QD for 7-14 days
Itaconazole oral solution 200 mg PO QD for 7-14 days
Clotrimazole troches 10 mg PO 5x/d for 7-14 days
Nystatin suspension 4-6 mL QID or 1-2 flavored pastilles PO 4-5x/d for 7-14 days
Itraconazole oral solution 200 mg (or more) PO QD
Amphotericin B deoxycholate 0.3 mg/kg IV QD

Recommended treatment of OPC in children and infants:

Fluconazole 3-6 mg/kg body weight (max 400 mg/dose) PO for 7-14 days
Itraconazole cyclodextrin oral solution 2.5 mg/kg body weight (max 200-400 mg/d) for 7-14 days)
Clotrimazole troches 10 mg PO QID for 14 days
Nystatin suspension 4-6 mL PO QID or 1-2 flavored pastilles PO 4-5x/day for 7-14 days
Itraconazole cyclodextrin oral solution 2.5 mg/kg body weight PO BID (max 200-400 mg/day) for 7-14 days
Amphotericin B oral suspension 1 mL (100 mg/mL) PO QID for 14 days or less

Hairy Leukoplakia: There are both local and systemic treatment options for Oral Hairy Leukoplakia (OHL). Local treatments often include the use of topical podophyllum resin (POD) and/or surgery. POD is made from different plants such as American mandrake and Indian apple. POD must be used with caution to limit toxicity. Large amounts of POD may result in serious system adverse effects and fatalities (Baccaglini et al., 2007). Topical treatment is ideal for small, contained lesions and is impractical for very large lesions. Systemic antiviral treatments may include antivirals such as desciclovir, valacyclovir and acyclovir but recent studies show that they are not as effective as local treatments with topical drug application and/or surgical removal of the lesion.

Osteomyelitis of the Jaw: Osteomyelitis is most commonly affects the mandible compared to the maxilla. Treatment is dependent on various factors such as which stage in the Cierny-Mader Classification system it’s in, which pathogen is involved and what other comorbidities the patient may have. Treatment may involve sequestrectomy (removal of dead bone that is separated from the rest of the jaw), hyperbaric oxygen therapy, resection and reconstruction of the jaw, drainage of the infection, specific antibiotic prescription based on pathogen cultured, and debridement of the area.

Ulcerative Gingivitis: Treatment for ulcerative gingivitis includes debridement, antiseptic mouth rinse such as chlorhexidine or hydrogen peroxide, improved hygiene and antibiotics. Treatment should be divided into 4 stages:

Stage 1: Stop the disease process and control patient discomfort and pain
Stage 2: Treat the preexisting chronic gingivitis through professional prophylaxis and/or scaling and root planning
Stage 3: Corrective treatment of disease sequelae with procedures such as gingivoplasty and/or gigivectomy
Stage 4: Maintenance through compliance with oral hygiene practices and controlling predisposing factors

References

Baccaglini et al. (2007). Management of oral lesions in HIV-positive patients. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontology, v.103, S50.e1-S50.e23. https://doi.org/10.1016/j.tripleo.2006.11.002

Campbell-Yesufu, O. T., & Gandhi, R. T. (2011). Update on human immunodeficiency virus (HIV)-2 infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 52(6), 780–787. https://doi.org/10.1093/cid/ciq248

Cawson, R., Bonnie, W. & Eveson, J. (1994). Color atlas of oral disease: Clinical and pathological correlations. Wolfe Publishing.

Hanley M., Hendriksen,S. & Cooper, J. (2020). Hyperbaric treatment of chronic refractory osteomyelitis. Treasure Island (FL): StatPearls Publishing. PMID: 28613536

Malek,R., Gharibi, A., Khlil, N. & Kissa, J. (2017). Necrotizing ulcerative gingivitis. Contemporary Clinical Dentistry, 8(3), 496-500. https://doi.org/10.4103/ccd.ccd_1181_16

Top Tricks For Effective Studying

Pre-Med

Successfully finishing undergrad on a pre-med track requires strategizing. When I first started taking science classes, I felt like medicine wasn’t for me. I had zero background in science and I was working a full-time job. I felt like I’d never catch up to my classmates, or better yet, pass the classes I was taking. That was when I earned my first C freshman year. I was taking Human Biology at a local college in my hometown and thought my horrendous high school study habits were sufficient to get me through college level classes. I was rudely awakened to the fact that my method of studying was no where near what was required for a successful run at a college level class.

The process of perfecting my study habit and finding a flow that worked best for me was a slow a strenuous one. I’d say it took the entirety of my freshman year, and maybe even some of sophomore year, for me to start to really get the hang of it and not feel like I was in a constant state of TRYING NOT TO DROWN!

First, before I get into the tips, I want to introduce you to my 5 phases of studying. I’ve realized over the years that I study best and learn best when I follow specific steps and study in a certain order. I divided the process into 5 phases and I go through each in the same order every time. I try to not skip phases unless I’m falling really behind or feel like the material is easy enough to where I can jump straight into practice. All of these phases are after lecture and after I have skimmed through the material either before or after class (depending on my availability). The phases are as follows:

Recall Phase: The first step in studying the material I am learning. This involves me using active learning practices such as brainstorming what I remember from lecture, drawings pictures, writing out ideas, creating a song/poem or creating a poster board. The best thing to do is review information from class after a break in between, not immediately after lecture. This may seem difficult at first because you realize there are gaps in what you can recall, but that’s OK! It means you need to retrieve information from memory which is what we want to master anyways.

Action phase: This is where what I’m learning is put into practice. I do as many practice problems, exams, quizzes and tests that I can get my hand on. In this phase, I am not yet testing myself. I am using my notes and videos to guide me through the problems. I mark down questions I am getting wrong and do them until I understand my error and corrected it.

Testing phase: This is where I do exactly what I was doing in the action phase, but I use no help at all. I do everything by myself and grade my own practice as if I had taken an exam. This phase is extremely important because you may be do extremely well in practice when you have an aid and realize you are still getting stuck when you have to critically think through problems on your own.

Review phase: The review phase includes going over any final topic or material that you are still struggling with. If you are struggling after the testing phase, seek help from your professor or a classmate that understands the material better than you. Don’t be afraid to use outside resources for your own benefit. They are there for a reason!!!

Elaborating phase: This phase isn’t always possible, but it’s my favorite because it really helps me solidify what I know and makes me feel like I’m a smart cookie. I try to teach the material to either someone else or myself. This literally means talking out loud and, FROM MEMORY, going over everything I know from the topic and explaining it as if I was teaching it to someone who never heard of it before.

One of my favorite resources for learning better studying techniques is the learning scientists blog. On their website, you can find more resources on what they consider to be the best six strategies for effective learning. I personally practice at least 4 of them during my studying sesh on any given day.

1. Ditch the flashcards

Don’t get me wrong, flashcards can work wonders when you are trying to simply memorize information short-term. As you all very well know, if you are trying to pursue a graduate career past your undergradhate degree, a lot of the information you are learning (especially core science or science related courses) will come back to haunt you. You will either have to know it for the MCAT or for the first year of medical, dental, pharmacology and vet school. Don’t underestimate the future need for the information you are learning. Merely getting an A in the class should not be your main priority. You want to really learn and understand the material. Instead of flashcards, consider incorporating active learning into your studying. Refer back to my initial phase of studying description to get an idea of what active learning may look like.

2. Space out your studying

The worst thing you can do to yourself is try to cram an entire week of material into one day of studying. It doesn’t work! 7 hours of studying on a Saturday is not the same as 1 hour of studying 7 days a week. The latter results in you not retaining the information and is exhausting. Work out a healthy balance between your work, personal and school schedule and ensure you give yourself personal time for hobbies and relaxing. Space out your work over several days or blocks throughout your day so that it adds up to your goal time. For example, wake up an hour earlier and spend 45 minutes in the morning reviewing for course A. Then, at lunch from work, review what you did in the morning. After work, don’t do anything related to course A. Focus on a different course and swap the schedule the next day so that course A is your evening focus.

3. Make connections

Memorizing words, formulas or basic ideas can be fairly easy, but what is required for you to really learn and understand the material so that you never forget it again? How do you master a subject? My favorite technique for mastery involves making meaningful connections between what I am learning and something that is engraved in my brain. I read a book once about the mastery of memorization (click here to buy it on amazon) and I learned a thing or two about how to make things stick. One trick I found interesting in the book was making absurd connections to what you are trying to learn. So, when I say “meaningful” I mean something out of proportion, unreal or exaggerated. For example, mnemonics work best when they are funny or even slightly inappropriate. Mnemonics are not very useful unless you can memorize the phrase, right?

4. Condense information

I am a big visual learner and I believe most people are too. For me, fitting all of the information that was being taught (even if it was 70+ slides on a powerpoint) into ONE sole typed out sheet of paper helped me visually see the information in my head during exams. Sometimes, I have to make my letters really small, but I color coordinate the information and add tables or small figures to help. Adding figures is most effective when you are drawing them yourself and personalize them to what your understanding of the material looks like. I add the most important information from the entire powerpoint or chapter and study only this one sheet of paper. This helps the information not seem so daunting and you don’t have to flip through pages and pages of scribbled notes or useless information. You don’t feel as overwhelmed and when exam time comes, you are able to visualize what was written on that page to use either process of elimination or recall to answer the question. DO NOT READ THROUGH NOTES OR READ THROUGH THE POWERPOINT FOR REVIEW. I promise you, this is a waste of your time! The information will go in one eye and out any other hole you have except stay in your brain like it’s supposed to. Like I said, active studying is the most effective form of studying there is.

Here’s an example of a poster I made for organic chemistry to help me understand functional groups better:

5. Get a planner. Yes, like middle school

Remember when you were in middle school and you would get personalized planners for the school year? Your teachers would have you write down your homework for the day or assignments that were due in your planner so that you wouldn’t forget? I know it sounds childish but there is nothing better than being organized. Even if your brain is moving at 100 mph all of the time, you can still learn to slow down buy using a calendar. There is no task too small for planning. I like to plan out my entire week on Sunday evenings. I sit down at my desk at home and I write down everything that is due that week on a sheet of paper. Then, I write down things I want to accomplish that week that are not associated with school such as gym time, personal time, mediation, grocery shopping, errands… literally ANYTHING else.

I divide my tasks into blocks on my schedule and don’t ever schedule over 2 hours of studying in one sitting. We think we get more accomplished based on the time we spend doing it, but that’s not necessarily true. I decided that my max time was 2 hours but every person’s stop time may be different. A good way to know when it’s time to stop is when you no longer feel focused on the material and are just reading through or trying to rush through the information to finish the task or assignment. The extra time you spend doing that is ineffective and wasteful. You could be spending that time doing something for yourself like going for a run or playing with your dog. Take breaks and make time for healthy habits in your life. You will never be a good doctor if you are not in good health. Personalize your calendar to best fit your sleep schedule, life and goals. Being organized is important in every aspect of life. Remember: the only way to not get behind is to stay ahead!

Kyphoplasty

Medicine and Health

As I’ve mentioned before, I am currently working as a medical assistant in pain management. It’s now been almost a month that I started my new job and I love it! I get to work alongside the best pain management doctors in my area and have learned so much in a short amount of time. Last week, I had the privilege of shadowing several Epidural Steroid procedures as well as a Kyphoplasty procedure. It was the coolest thing I’ve seen since tori removal back in my oral surgery days. If you don’t know what a Kyphoplasty is, keep reading because this post is all about it!

What’s a Kyphoplasty?

A Kyphoplasty is a procedure performed to correct vertebral compression fractures (VCF) through the use of polymethylmethacrylate (PMMA) aka bone cement. The leading cause of VCFs is osteoporosis (Cooper et al, 1992), but falling or high risk activities like lifting heavy weights could also lead to a fracture. Due to the nature of the fracture, VCFs can be very painful; the vertebral body collapses causing the patient to lose height in their spine. During the procedure, a hollow needle is inserted into the body of the vertebra through the pedicle. An inflatable balloon is then placed inside, inflated to restore the vertebral height and to create a working channel for the cement to flow into. The entire procedure is guided through a fluoroscope and contrast medium.

Why a Kyphoplasty?

Other treatment options for patients with painful VCFs include non-surgical management (NSM) and a Vertebroplasty procedure. A Vertebroplasty is very similar to a Kyphoplasty. The primary difference is that a balloon is not used to create a working space for the cement to flow into and the cement used tends to have a lower viscosity. Both of these factors increase the most pertinent risk associated with the procedure: bone cement extravasating into the epidural space. Without a working space, the physician doesn’t have as much control of where the cement is flowing into. Also, bone cement viscosity is identified as a decisive guideline influencing leakage in a Vertebroplasty, so using a cement with a higher viscosity reduces the risk of extravasation (Giannitsios et al, 2005). In fact, the incidence of leakage during a Vertebroplasty ranges between 2-67% compared to 0-13.5% for a Kyphoplasty (Denaro et al, 2009). Other risks to consider include heart attack, cardiac arrest and stroke. In addition to surgical procedures, there are also NSM options for patients with VCFs. These include bed rest, pain relief medication and back bracing. Compared to patients who undergo a Kyphoplasty procedure, patients following a NSM treatment plan for VCFs experience less pain relief and improvement (Meirhaeghe, 2013). For these reasons, if a non-surgical treatment is insufficient, a Kyphoplasty is often the preferred treatment option for VCFs.

What are the main indications for the procedure?

Patients with Osteoporosis
Patients experiencing intense pain adjacent to the level of the fracture
Patients diagnosed with a fracture by an MRI, CT or X-Ray
Patients who failed non-surgical management for at least 4 weeks
Patients with lesion causing benign and metastatic tumors

Which patients are not candidates for the procedure?

Patients who did not fail non-surgical management for at least 4 weeks
Patients with asymptomatic vertebral compression fractures
Patients with allergies to materials used in the procedure such as PMMA or barium contrast
Patients with bleeding disorders that are unmanageable

How is the procedure performed?

The patient is placed on the table, face down with a gown open to the back. The patient’s skin where the needle will be inserted is prepped with an antiseptic solution. Most patients are sedated for comfort and since the procedure is minimally invasive, local anesthetic is primarily used.
The provider starts by inserting a bone access needle into the area affected to determine the trajectory of the working cannula. Once it’s confirmed through the fluoroscope that the access needle is at the correct location (on pedicle of vertebra), a bone drill is used to create a pathway through the pedicle into the vertebral body.
Once the pathway is created, a curved-tip osteotome is inserted into the vertebral body and manually curved/directed towards the fracture.
The balloon is inserted through the hollow needle and inflated to compact the soft porous bone inside of the vertebral body. Doing this not only restores the natural height of the vertebra but also creates a working channel for the cement to flow into. This decreases the chances of the cement flowing to places it shouldn’t flow into and gives the doctor more control of the cement’s trajectory. A contrast is used to visualize the inflation of the balloon and its location through the fluoroscope.
Finally, the balloon can be removed and cement is injected into the working channel under pressure using a special cement filler cannula. The pressure and quantity of cement being injected is strictly controlled to prevent leakage. The needle is removed slowly and carefully, ensuring the cement is not following the needle forming a “tail.” This is done by waiting for the cement to slightly harden and monitoring its progress through the fluoroscope.
The needle is removed and the incision is closed with either steri-strips or skin glue. Once the remaining cement on the table hardens, the patient is ready to be moved to the recovery room.

Pictures from the procedure I shadowed:

Works Cited

Giannitsios, D., Ferguson, S., Heini, P., Baroud, G. & Steffen, T. (2005). “High cement viscosity reduces leakage risk in vertebroplasty”. European Cells & Mat 10, Poster No. 314. http://www.ors.org/Transactions/5thCombinedMeeting/0314.pdf

McCall, T., Cole, C., Dailey, A. (2008). “Vertebroplasty and kyphoplasty: A comparative review of efficacy and adverse events.” Current Reviews in Musculoskeletal Medicine, Vol. 1: 17-23, doi: 10.1007/s12178-007-9013-0. https://link.springer.com/article/10.1007/s12178-007-9013-0

Meirhaeghe, J., Leonard, B., Steven, B., Jonas, R. & John, T. (2013). A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures. Spine, Vol. 38(12): 971-983, doi: 10.1097/BRS.0b013e31828e8e22. https://pubmed.ncbi.nlm.nih.gov/23446769/

Denaro, V., Longo, U., Nicola, M. & Denaro, L. (2009). Vertebroplasty and kyphoplasty. Clinical Cases in Mineral And Bone Metabolism: The Official Journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, Vol. 6(2): 125-130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781232/

My International Medical Volunteer Trip

Pre-Med

This is Alberto. He was my favorite resident. He loved to dance and sing
Picture is a husband who moved into the nursing home to be with his wife who has dementia
I painted the resident’s nails during down time. Linda loved her new pink nails
I helped cook, feed and clean the residents. Here’s a picture of me in the kitchen
This woman was 107 years old. She was the sweetest resident there and I loved spending time wit her
Me at La Paz Waterfalls interacting with butterflies

This week’s blog will be a little different than the usual. Instead of me taking the lead, I let you guys ask questions about my volunteer trip abroad. In December of 2019, I went on a 1 week medical mission trip to Costa Rica. I graduated that same month and that was my graduation gift to myself. It was one of the best experiences I’ve ever had and it made me realize how much I love volunteering and why I want to be in medicine. I could sit here and write 10 pages on my experience and why I think everyone should do an international volunteer trip at least once in their life. Instead, I’ll answer questions you guys have about my trip.

Here are answers to the top asked questions about my trip:

1. What organization did you use?

I volunteered with International Volunteer HQ. I researched different organizations for a couple of weeks, and decided that IVHQ was the one for me because it was affordable and I felt safe traveling with them. I joined their facebook group and asked questions to current and past volunteers about their experiences and how they liked it. Every person I asked said their trip was very safe, the organization was reliable and their experience was life changing. IVHQ also had the most destinations available in comparison to other organizations. Their projects aren’t all medical, this means that if you want to volunteer in a different area or let your talents shine, you can.

Aside from Medical and Health, some of their other projects include:

• Childcare
• Teaching
• Wildlife and Animal Care
• Construction and Renovation
• Environment and Conservation Arts and Music
• Sports
• NGO Support
• Refugee Support
• Women’s Empowerment
• Community Development
• Elderly Care
• Special Needs Care

They have volunteer opportunities in:

• Africa (Ghana, Kenya, Madagascar, Morocco, South Africa, Tanzania, Uganda, Victoria Falls, Zambia)
• Middle East (Jordan)
• Asia (Bali, Cambodia, China, India, Laos, Nepal, Philippines, Sri Lanka, Thailand, Vietnam)
• North America (Mexico, United States)
• Central America (Costa Rica, Guatemala)
• Caribbean (Belize, Jamaica, Puerto Rico)
• South America (Argentina, Brazil, Colombia, Ecuador, Peru)
• Europe (Belgium, Croatia, Greece, Italy, Portugal, Romania, Spain)
• Pacific (Australia, Fiji, New Zealand)

2. How much did it cost?

Every project and destination will have a different cost. The cost depends on where you go, what project you are doing, how long you will be staying and whether you will want to do other “touristy” activities before you leave. The Costa Rica medical trip I went on was only $445 for 1 week. The rest of the cost covered flights, a background check, transportation and other small fees like lunch and snacks. The program was very independent. We were volunteering through their local organization called Maximo Nivel and aside from being dropped off at our host family’s house, we had to get around on our own.This meant taking the bus to and from work and doing anything else while we were there. In total, I spent about $1,300 for everything. The most costly were the flights because I booked them last minute and couldn’t find any deals ($600 for round trip, ouch!). I didn’t have to pay for breakfast or dinner because my host mom cooked for me and of course, I stayed at her home for free. I only had to pay for lunch and transportation. Tourism was an option, but the cost of my trip would’ve increased and I would’ve had to extend the trip to accommodate the extra activities. Considering I was there to primarily volunteer, I didn’t worry too much about the extras. I wanted to volunteer and live like a Tica for a week. I rode the bus, ate Gallo Pinto, and practiced my Spanish. Depending on how much money you have to spare, you can add different excursions and activities to your trip to mix tourism and volunteering. It’s entirely up to you!

3. Were you allowed to do “hands-on patient” work?

Yes and no. I was required to submit proof that I was a pre-pa, pre-medical or pre-dental student. I also had to submit proof that I had some sort of experience in the medical field. Not every volunteer needs to do that though. Depending on how many science classes you’ve taken and your major, you don’t have to provide proof of Certification or health care experience. Since I was just starting my pre-requisites, I submitted proof that I was a Certified Expanded Functions Dental Assistant (CEFDA) and had 2 years of experience. I worked in a nursing home and was able to shadow the nurses, doctors, nurse practitioners and physical therapists. I was also able to feed the patients, transport them, help change their clothes and participate in fun activities. Aside from patient care, I helped with laundry and cleaning. My house-buddy was in nursing school at the time and she volunteered with me at the same nursing home. She was allowed to do a little more than I was, so it really depends on your experience and how much you know. Everyone was very supportive and trusting. They let you get as much hands-on as you want, you just had to take the initiative.

4. Were translators provided?

No! Translators were not provided and we had to get by on our own. This was intimidating at first but I am so thankful for it. I practiced my Spanish the entire week and came back home speaking Spanish 10x better than before I left. A lot of my friends there had google translate open and used it to communicate. I spoke the most Spanish out of our group, so most of the time, I was translating for them. Costa Ricans are very welcoming and had no problem trying to communicate with us. Don’t be shy if you don’t speak Spanish or the language spoken in the country you volunteer at. Embrace the experience and communicate through compassion. A smile is understood universally, so is a hug, a handshake, a pat on the back. Use hand gestures and body language to communicate. If you want to practice and learn the language, they did offer Spanish classes for students who were interested. The classes were divided into different levels and ranged from $125 to $390 a week depending on whether the class was private and the size of the group. So if you are intimated by the language barrier, that is always an option. A little costly, but, an option.

5. Did you volunteer the entire time or were there other activities?

I mostly volunteered, but there were options to do a lot of other activities. Some volunteers were planning on staying for weeks or months, so they traveled during the weekend to different tourist spots. I was only there for 1 week, so I wanted to spend 95% of my time volunteering. Various activities and excursions were offered through the organization and they were affordable. Some volunteers decided to explore on their own and utilized Uber or public transportation to site-see on their own. Unless you are with a group, I wouldn’t recommend that because it’s not as safe as having a guide. I volunteered the entire week and on my last day went to La Paz Waterfalls with friends I made on the trip. It was a lot of fun and since there was a big enough group, we were able to split the fare making the excursion fairly inexpensive. If you have more than a week to spare, you can chose different volunteering and tourism options. Some volunteers will work for 1 week and travel for the other or will travel on weekends and work the full 2 weeks. It all depends on how much money you want to spend and how much time you to have to spare.

6. Did you pay for everything alone?

Almost. I had $200 in donations from family and friends to help fund my trip. The rest was paid 100% by me. If you are concerned about how you will afford the trip, try fundraising. You can use Go Fund Me or sell baked goods to raise the money. I didn’t sell any goods to fund my trip because I didn’t have the time. I was working and finishing up my Bachelor’s, so I decided to bite the bullet and gift myself the opportunity. From my personal research, IVHQ seemed to be one of the most affordable organizations to travel with. There are also church and school organizations that participate in international volunteer trips. If you don’t have the money to spare for IVHQ, you can always seek opportunities at your University and church.

7. Did you feel safe throughout the trip?

Yes. Costa Rica is a very safe country. Did you know they don’t have a military? Since I was traveling alone, safety played a big role in me picking Costa Rica as my destination. Of course, I took extra precautions because there are bad people everywhere. I did not travel with any expensive jewelry, kept my phone put away, and didn’t go anywhere alone. Like I said, we traveled around the city by ourselves and utilized public transportation because it was cheaper than Uber. Not once did I feel unsafe. I always had a friend with me and maintained full awareness of my surroundings. Unfortunately, I can only speak for Costa Rica. Check out the IVHQ Facebook page and ask around. There are volunteers in that group from all over the world and they can give you more insight on the safety of their destination.

8. Did you learn anything important that you’d like to share?

Oh, absolutely! First, I learned that I am 100% meant to be in medicine. Costa Rica was beautiful and traveling was fun, but my favorite part was being in the nursing home and working with patients. I loved spending time with the residents, getting to know them, and being hands on. When the week was over, I didn’t want to come home. I wanted to stay and work more. It really showed me how much I love what I do and how much compassion good quality health care requires. It takes more than being clinically sound to be a good physician or any provider of care. It takes patience, compassion, understanding, and love for your neighbor. This is one of the reasons I think everyone should volunteer abroad in a health care setting. You will know right then and there if you are seeking medicine because you love it or not.