In the field

Global outreach: How to rotate with DOCARE in Guatemala or Nicaragua

DOCARE rotations are an affordable way for students and residents to get a meaningful international learning experience, participants say.

In a neatly painted brick building in San Andrés Itzapa, Guatemala, Alexandra Villapiano, OMS IV, is helping counsel an elderly couple who have diabetes at DOCARE’s continuity of care clinic. Villapiano is completing a four-week clinical rotation at the clinic and says she’s already learned priceless lessons on connecting with patients from the clinic’s permanent staff, especially Dr. Rudy “Erik” Hernández, a Guatemalan physician.

“In addition to practicing Spanish, I’m being immersed in the way this culture sees medicine—for example, many patients are resistant to taking medications,” says Villapiano, who attends the New York Institute of Technology College of Osteopathic Medicine in Old Westbury. “Dr. Erik has taught me so much about how to gain patients’ trust and how to treat them with an understanding of their needs and concerns.”

Alexandra Villapiano, OMS IV, reflects on her rotation at DOCARE's permanent clinic in San Andrés Itzapa, Guatemala.

Alan Schalscha, DO, who directs DOCARE’s Guatemala clinics, says students who rotate internationally gain valuable insight into how local resources, or lack therof, can impact the delivery of care. “In the U.S., if somebody’s diagnosed with diabetes, we’d give them a diet and ask that they adhere to it,” he explains. “Here, the local diet only has one source of carbohydrates, so we have to be a little more creative.”

‘I don’t think anyone would regret going’

Catherine Pinkston, DO, completed a month-long rotation at DOCARE’s San Andrés Itzapa clinic in 2015 as a fourth-year medical student. The experience was so memorable that she joined DOCARE’s board and plans to return to San Andrés Itzapa this summer for a four-week residency rotation.

“If you’re even remotely interested, you should definitely do an international rotation with DOCARE. I don’t think anyone would regret going,” says Dr. Pinkston, who is now a family medicine resident in Cincinnati.

Another benefit of DOCARE’s global health rotations is their affordability, Dr. Pinkston notes. The application fee is $300, but there is no cost for the rotation itself. Dr. Pinkston says she spent less than $2,000 on her month-long rotation in Guatemala. That amount of money covered her travel costs including airfare, housing, food and recreation. Third- and fourth-year osteopathic medical students can apply for grant funding through the American Osteopathic Foundation’s HOPE Grants program.

How to rotate with DOCARE

DOCARE offers rotations for students and residents at its continuity of care clinics in San Andrés Itzapa, Guatemala, and Chacraseca, Nicaragua. A third permanent clinic in Tecpán Guatemala, Guatemala, will begin offering rotations soon. DOCARE recommends four-week rotations, but can accommodate rotations as short as two weeks. Here’s how to participate:

  1. Become a DOCARE member if you’re not already. You should also be in good academic standing.
  2. Decide where you’d like to conduct your rotation. To rotate in Guatemala, you should have a working knowledge of Spanish. In Nicaragua, interpreters can be hired for an additional fee.
  3. Secure permission from your school or residency program.
  4. Request an application packet by contacting Samyuktha Gumidyala, AOA chapter relations specialist, at or (312) 202-8101.
  5. Complete and submit your application as early as possible, but at least 60 days before your trip, along with a nonrefundable application fee of $300. “Certain months are really popular for rotations, so the earlier you apply, the better,” advises Dr. Pinkston, who applied a year in advance. “But the application itself is easy; it’s not long or involved.”
  6. Once you’ve been accepted, purchase airline tickets and travel insurance. DOCARE arranges transportation from the airport to your clinic site, the cost of which is included in your application fee.
  7. Organize your housing. If you’re rotating in Nicaragua, the DOCARE clinic there will arrange for you to stay at a home/retreat facility beside the clinic. If you’re rotating in Guatemala, you will arrange your own housing, but DOCARE will provide suggestions.
  8. Get ready for an eye-opening experience. “To get the most out of an international experience in a country like Guatemala, you have to have an open mind, be flexible and friendly, and immerse yourself in the culture,” advises Dr. Pinkston.
  9. To learn more about DOCARE rotations, contact Samyuktha Gumidyala, AOA chapter relations specialist, at or (312) 202-8101.

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