Celebrating 20 Years of Global Care in Guatemala

For 20 years, Case Western Reserve University Frances Payne Bolton School of Nursing students have traveled to San Raymundo, Guatemala, with the mission group Refuge International, providing medical care and services to a remote community with limited access to resources. Marie Grosh, assistant professor and the program's current director, describes the care students provide as full-service primary and surgical care. 

In 2005, Margaret Bobonich (CWR ’99, DNP), assistant professor in the Frances Payne Bolton School of Nursing, competed on the 11th season of the reality show Survivor: Guatemala. When Hurricane Stan devastated the country just after she had finished filming, Bobonich was compelled to return to the region and support the community. Bobonich returned to San Raymundo in February 2006 with Refuge International. That fall, Bobonich traveled there again, this time bringing four Case Western Reserve University Frances Payne Bolton School of Nursing Advanced Practice Registered Nursing (APRN) students on what has become an annual mission trip to provide medical aid to the region and give students hands-on patient care experience.

The Refuge International clinic is two hours from the nearest full-service laboratory; medical professionals are scarce and clean water is a continuous issue. Every year, students and faculty bring their own equipment to stock the facilities, including medications,  surgical supplies and ultrasound machines from Cleveland. 

“Our purpose is not to provide just nursing care, but to help create a structure, education and resources,” Bobonich said. “So that the people learn how to take care of themselves and how to teach the healthcare providers who remain there, so that when we leave, they can provide care while we are gone.”

Carol Savrin, a professor in the Frances Payne Bolton School of Nursing, was one of the initial faculty members to take students to San Raymundo alongside Bobonich. Since then, the trip has spanned 20 years, over 2,000 surgeries and over 12,000 primary care visits. Over the years, the trip has grown to include 10 students twice a year and has included nurse practitioners, midwives and anesthesiology students.

Over the week-long trip, students spend five days serving patients for about 11 hours each day, plus two days setting up and tearing down. The facility boasts a four-bay operating room, 6 room primary care clinic, in-house pharmacy and point-of-care labs. About 10-15% of patients require surgery, and the most common care students provide outside of surgery is diabetes, hypertension and reproductive health issues. 

Between assisting in the operating room, prescribing medications and diagnosing medical problems, students do it all. By providing start-to-finish patient care, students gain confidence in a fast-paced environment; afterward, students tell the program leaders they learned independence and autonomy, cultural similarities and differences, the benefits of collaboration and the importance of a thorough history and physical exam. 

The trips paused during the COVID-19 pandemic. Savrin and Grosh conducted telehealth visits between CWRU nursing students and patients at the San Raymundo clinic. The program has struggled with rising travel costs, but Savrin hopes its 20th anniversary will draw more donations and interest. 

Grosh, Savrin and Bobonich all want the program to continue growing with more students participating each year. In the future, Grosh hopes to potentially partner with other schools within the university, such as the physician assistant program, the medical, dental and social work schools, because “it's more than just nursing. Any healthcare professional can benefit from the experience.”

Last year, students on the trip assisted in 88 surgeries and provided primary care for 350 patients. The next trip will depart on Oct. 23 of this year. Students interested in applying to the next trip can do so in February 2027. 

At Homecoming and Reunion Weekend, the Frances Payne Bolton School of Nursing is celebrating 20 years of partnership with Refuge International on Friday, Oct. 9 at 3 p.m., at the Health Education Campus. The event will include a presentation, followed by a dean’s reception and a mission alumni and friends dinner. Students, faculty, staff and alumni are encouraged to attend. Register to attend the presentation here.