Continuity of care

How DOCARE’s permanent clinics are making a difference in Guatemala and Nicaragua

Local physicians at three permanent clinic sites in Guatemala and Nicaragua provide ongoing care for medically underserved patients.


In a rural part of central Guatemala, patients chat in the shade outside a hilltop clinic surrounded by lush flowers and trees. This is DOCARE’s newest continuity of care clinic, located in Tecpán Guatemala, which has a population of around 90,000 people and scant medical resources. Like DOCARE’s other permanent clinics in San Andrés Itzapa, Guatemala, and Chacraseca, Nigaragua, it’s staffed by local physicians. Patients receive free initial visits and pay a nominal fee for follow-up care.

These permanent clinics are the hub of DOCARE’s outreach efforts in Guatemala and Nicaragua. Shorter medical mission trips take place within an hour’s drive of a continuity of care clinic to facilitate follow-up care for patients who need it. The clinics offer month-long rotations for osteopathic medical students and residents.

Catherine Pinkston, DO, rotated at DOCARE’s permanent clinic in San Andrés Itzapa, Guatemala, as a fourth-year medical student. “I loved the fact that patients can continue to receive follow-up care from Guatemalan physicians,” says Dr. Pinkston, who’s completing a family medicine residency in Cincinnati and plans to return to the clinic this summer for another rotation. “Because they are local, the physicians are able to gain patients’ trust more quickly, which is especially helpful when treating people with chronic health issues.”

Patients gather outside DOCARE's newest continuity of care clinic in Tecpán Guatemala, Guatemala.

Osteopathic fit

Christina Ciraco, a fourth-year osteopathic medical student at New York Institute of Technology College of Osteopathic Medicine in Old Westbury, says osteopathic medicine is well-positioned to meet the needs of patients in rural Guatemala. Ciraco recently completed a rotation at DOCARE’s San Andrés Itzapa clinic, which serves a primarily indigenous population. “We saw many patients who have tension headaches or low back pain because they are laborers who work in the fields,” she explains. “Using OMT has been really beneficial, which is important for a population that’s often resistant to medication.”

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Amy Adams, DO, a DOCARE board member who helped set up the permanent clinic in Tecpán Guatemala, agrees that it’s crucial to take a holistic approach to treatment, especially when caring for patients whose everyday lives may be very demanding physically.

“If a patient complains of back or neck pain, you have to understand their daily life—are they carrying a heavy basket on their head while walking three miles to the market every morning?” says Dr. Adams, who practices surgical and medical dermatology in Laurel, Mississippi. By learning about a patient’s environment and routine, she says, physicians can offer practical guidance, such as putting a cushion beneath a basket being carried on the head.

Making a difference

On a recent two-week outreach trip with DOCARE, Dr. Adams helped care for a Guatemalan woman who complained of a burning sensation in her feet. A physical exam failed to find any issues, but a test revealed that the woman’s blood sugar levels were extremely high. DOCARE volunteer physicians diagnosed her with diabetes, explained her condition and started her on medication.

What happened next was just as critical as the initial diagnosis: the volunteers connected the patient with a nearby DOCARE continuity of care clinic. “Through the clinic, we knew she could continue to receive affordable support, medication, monitoring, and education, even after we were gone,” says Dr. Adams, noting the woman has already started meeting with a nutritionist at the clinic for follow-up care. “That’s a beautiful illustration of why continuity of care clinics are so important.”

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