Mission Trips as a PA: Inside Hands of Esperanza

I'm chatting with Ashley and Eryn from Hands of Esperanza, a nonprofit providing healthcare to rural areas of Guatemala that grew out of a PA school mission trip. Ashley is a transplant and hepatobiliary surgical oncology PA in Atlanta, and Eryn is an emergency room PA in Tampa. They both went to Nova Southeastern University in Orlando.

The group started Ashley's first year of PA school in 2014, because Nova didn't have a mission trip and a group of students passionate about global health wanted to create a legacy. A trusted professor connected them with an organization she trusted in Guatemala. They took their first trip in 2015 after their didactic year, with about 20 students, one PA, and one nurse. They did three days of remote rural clinics plus hospital and orphanage volunteering. They were hooked, and in June 2019 they formed their own nonprofit to fundraise for their biggest project: a multi-specialty medical and surgical center to provide sustainable, year-round care.

Their model is unique because it gives PA students their first clinical experience between the didactic and clinical years, putting their diagnostic skills to the test. The first day they hike to a remote village, unpack, set up rooms, and triage patients into primary care, pediatric, and OB/GYN stations. They typically see 200 to 300 patients a day in bursts, since people walk three to four hours from different villages. Over four days at a rudimentary school with open air walls and dirt or concrete floors, students learn to work without labs or x-rays, relying on history taking and physical exam skills.

After the four clinic days, they spend a full day volunteering in a hospital, participating in ER triage, labor and delivery, surgeries, and rounds. They also build stoves with chimneys to reduce the respiratory illness caused by cooking over open flames, having built 25 stoves in one year, and they install water filtration systems that last about 20 years. Patient education is central, including teaching families to boil water and treat conditions like scabies. Many patients speak a Mayan dialect called Poqomchi', so they translate from English to Spanish to Poqomchi'.

A common question is whether a PA still needs a supervising or collaborating physician abroad. The main barrier is ordering medications in the U.S. to bring along, which requires a physician prescriber to sign off. Once in Guatemala, they are not required to have a physician accompany them. All of their medical licenses are registered with the Guatemalan Ministry of Health, and they are transparent with patients that students are being supervised. For surgical trips, a surgeon and anesthesiologist or CRNA would likely be required, but for basic primary care they don't have laws requiring a physician present. With 15 PAs spanning ICU, pediatrics, ER, and surgery, the team has broad expertise.

Medically, they see a lot of upper respiratory issues, GI issues from waterborne worms, and aches and pains from manual labor. They bring nebulizers, deworming medication, and reading glasses, and they perform procedures like draining abscesses, removing superficial lipomas, removing foreign bodies, and even removing a Nexplanon. A major focus is OB/GYN and public health, and the rate of STDs has dropped dramatically over five years thanks to treatment and education. The biggest barrier is nutrition, since about 83% of the local population lives below Guatemala's poverty line. [VERIFY]

There are many ways to help. The first is simply spreading awareness of the mission. The second is donating, whether financially, with supplies (their website lists commonly used over the counter medications), or with your time as a volunteer. The third is volunteering through their partner organization in Guatemala, Living to Serve, which runs trips year round for all ages and abilities, including options that don't require hiking. Pre-PAs interested in public health education can find a role there too.

On costs, building a stove runs about $200 to $250, and the conservative estimate for the two-level multi-specialty clinic with a surgery center is $450,000, with land already purchased and a perimeter wall under construction. [VERIFY] Their mission trip costs about $1,100 including flight and main meals, which is lower than many comparable trips, and many students fund it through GoFundMe. [VERIFY] Their top advice for first-time mission trip participants is to stay flexible and go in open minded without rigid expectations, which, as they note, is exactly what being a PA requires.

Medical missions are a powerful way to serve and to grow as a future provider, and Hands of Esperanza shows what a PA-led effort can build. If global health is calling you, start by spreading the word, donating, or exploring a trip with their partner Living to Serve. And if you want to weave service into your pre-PA journey, we're happy to help you think it through.