MEDEX Health Educators Empower Salvadorian Volunteers

By: and   April 12, 2016

Lois Thetford, PA-C, MEDEX didactic faculty
Sherry Lipsky, PA, MPH, PhD, retired UW faculty

This past November, two MEDEX graduates participated in a community health development project in the El Salvador village of Las Delicias, population 3,000. Sherry Lipsky (Seattle Class 9) and Lois Thetford (Seattle Class 14) collaborated with the small local clinic funded by the Foundation for International Medical Relief for Children.

The clinic has a paid part-time pediatrician working 4 hours a day, 5 days a week, along with a medical assistant and a volunteer coordinator. Located 35 km outside of the capital city of San Salvador, Las Delicias has no paved roads or street lighting, and is without running water or a sewage system. This rural village has a small retail store and a small bookstore with minimal open hours and limited materials.

Members of the El Salvadorian community of La Delicias practice fluoride application.

The Community Leadership Group conducts a walking resource survey in the town.

The only store in the town of Las Delicias.

Mural at the community preschool in Las Delicias.

Children at the preschool in Las Delicias.

Children at the preschool in Las Delicias.

Making pupusas for the Las Delicias community.

Lois Thetford, PA-C, teaches an oral health presentation in Spanish.

The Las Delicias leadership group practicing fluoride application.

After instruction from Lois the Leadership Committee practices fluoride application.

Applying fluoride to the teeth of a local child.

Dr. Tania Lopez of the FIMRC clinic, the sponsoring agency.

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After a day of introductions and walking around the village, the group of 10 women—Lipsky, local volunteers, and myself—devised a plan for the week. On the second day I gave a class on dental health and prevention. Lipsky had solicited and received 400 free fluoride treatments. We practiced doing fluoride applications on each other and, on the following day, the newly trained community group performed fluoride treatments on 65 people. All those who showed that first day were provided toothbrushes and toothpaste.

Unpaved roads of the Salvadorian town of Las Delicias.

Unpaved roads of the Salvadorian town of Las Delicias.

The following day we engaged people in writing out what they liked about their community, and what they wanted to change. These details were captured on poster paper, and were referenced during a focus group the next day. A pastor and a number of men from the community joined the focus group, and a long list of possible improvements was made. Molly, a local clinic volunteer, facilitated this discussion, probing and encouraging people to share their concerns and thoughts.

Building on that experience, Lipsky then instructed the locals on how to conduct a community survey—how to ask questions, how to randomize, and how to use the findings. The focus group list from the previous day was used as an example. A map of the community was updated and annotated for community resources and possible sites of future projects. One such community project in planning is the development of a public water system. The town’s existing primary physical and programmatic resources include a community hall with an adjacent kitchen where food is cooked for the elders and the neighboring preschool.

Italo applying fluoride to an older male member of the community.

Italo applying fluoride to an older male member of the community.

On Friday we held a Health Fair with lots of activities for the kids: coloring, refreshments, a piñata, as well as dental applications and workshops. One of the young women we had certified in First Aid/CPR did two demonstrations during the Health Fair. Two of the local women and I presented a nutrition workshop. 76 people received dental applications and received toothbrushes, with toothpaste 1 per household. We used toys in the piñata instead of candy to accentuate the dental prevention message.

Earlier in our visit, I worked with a small group of women volunteers, coaching them in how to recognize and talk about sexually transmitted infections. On Monday one of the women took on presenting this to the larger group and a rich discussion grew around the topic of safer sex, respectful sexual relations, and the need for a larger discussion between partners.

Lipsky teaches the skills of conducting a community health survey.

Open wide!

Please, open wide!

Children delight at breaking a Minion piñata at the health fair.

Children of the town of Las Delicias at a first aid demonstration.

Lois conducts a nutrition presentation at the health fair.

Lois begins a discussion on sexual health issues with the adults in the community.

Community leader Cecilia discusses sexually transmitted infections.

Folk art made from dyed sugar artfully placed on the road at the University of Central America in San Salvador.

“We are committed to a just society— all different, all equal.”

An image of solidarity is a symbol of recovery from the Salvadorian civil war.

Students hold portraits of martyrs from the Salvadorian civil war.

Procession of the clergy in San Salvador.

Gallery of portraits depicting the persecution of the clergy in El Salvador over the years.

An LGBT organization that works on HIV and human rights in El Salvador.

At the conclusion, the leadership team evaluates the health fair.

Saying goodbye to new friends.

Folkloric dance by Las Delicias teenagers who are part of the leadership group.

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On the final day, the core volunteer group evaluated what had been successful, what they wanted to do next, and how to move forward with their goals. All the trainings were greatly appreciated and it was decided to hold monthly gatherings and present further topics. We provided them with pamphlets on “Living Free from Violence,” and the book “Donde No Hay Doctor Para Mujeres” (“Where There Is No Doctor for Women”), which we had used in the trainings. We celebrated with pizza for the whole group, and the young women performed folkloric dances. Lipsky presented the volunteers with a photo album of the week’s activities.

Founder and director of Entre Amigos, the LGBT organization in San Salvador.

Founder and director of Entre Amigos, the LGBT organization in San Salvador.

Lipsky and I also visited Entre Amigos in San Salvador, a long-standing LGBT group that focuses on human rights, healthcare for persons with HIV and sexually transmitted infection.

On the weekend, we were fortunate to attend the commemoration and rally at the University of Central America in San Salvador, where 6 priests and 2 women were massacred during the previous civil war. All the martyrs were represented in photos and artworks, including Archbishop Oscar Romero, who was murdered during a Catholic mass. The Salvadorian civil war lasted 12 years from 1979 to 1992. During those years over 500,000 refugees left El Salvador due to death squads and the inability to work or feed their families. The right-wing death squads were responsible for extrajudicial killings or forced disappearances targeting healthcare workers, priests, and anyone who supported the peasants.

Our final day celebration in Las Delicias.

Our final day celebration in Las Delicias.

While Las Delicias has many challenges, the Leadership Committee came together, gained confidence, gathered experience and prioritized issues they wanted to address. Our leadership group was comprised entirely of women, ranging in ages from 15 to 45. A primary outcome of this week was that each woman gained more knowledge of how to work in her own community, as well as a sense of her own personal empowerment.

Lois Thetford, PA-C is on the faculty at MEDEX Northwest and teaches maternal child health. She can be reached at

Sherry Lipsky, PA, MPH, PhD is retired UW faculty. She can be reached at