Yale Health CORE 2009

Introduction
• A group of students from Yale School of 
Nursing and Yale School of Public Health 
visited Isla de Mendez, El Salvador from 
March 6th‐March 14th, 2009 to contribute to 
public health efforts in the village.
 Our Activities of the Week
• Health Fairs 
• Reproductive health sessions
• Nutrition, hand‐washing, and dental health 
education in the public school
• Respiratory Health Survey
• Other activities
 Health Fairs
• Held 3 Health Fairs covering 
parishes of the 5 churches of 
Isla 
• Objectives: 
– To thank the community for 
hosting us
– Educate and inspire children 
and adults about sanitation, 
hygiene, nutrition
– Encourage stewardship of land 
and health
– To provide hypertension 
Screenings
 Our Program
• Introduction and 
welcoming address

• Skits, songs, hand‐
washing demonstrations, 
and calesthenic exercise 
routines with children and 
adults

• Hypertension screenings 
of adults conducted by 
nursing and medical 
students
 Outcomes
• Over 250 people, both 
young and old, in total 
attended the health 
fairs.
• Approximately 65 people 
were screened for 
hypertension. 
– Those with high blood 
pressure were referred to 
the village doctor who 
proceeded to provide free 
medication and care. 
Reproductive Health
Monday
– Three visits to mothers in their homes
– Assessed their comfort level and 
familiarity with 
• reproductive anatomy
• puberty
• pregnancy prevention 
• sexually transmitted infections
• physiology of pregnancy
• communication
– Discussed misconceptions and supplied 
accurate information 
– Emphasized importance of their 
relationship with their children’s 
understanding of reproductive health
Reproductive Health
Tuesday
– Met with 22 adolescent girls next to health 
clinic
• Theme: getting to know ourselves 
– Peer‐to‐peer self‐esteem exercise
• Girls wrote positive descriptors about each 
other
– Anatomy and Physiology lesson
• In groups 5‐6 people, girls completed 
worksheets identifying anatomical names 
of male and female reproductive organs
• Worksheets were reviewed and answers 
provided as a large group
– Menstruation explanation
• Each girl was given a handout with 
illustrations and descriptions about the 
menstrual cycle
• Handouts were explained orally and 
information about personal hygiene was 
emphasized 
Reproductive Health
Tuesday
– Met with 16 adolescent boys
– Discussed definition and importance of self‐
esteem 
– Identified individual life goals
– Played “Life Soccer,” where making a soccer goal 
was analogous to achieving a life ambition, with 
defenders representing challenges and 
teammates serving as 
resources/support/decisions
– “But I feel like it!” activity
• Everyday feelings and alternative responses 
were identified, led to discussion of sexual 
desires, hormones, and appropriate reactions
– Completed and reviewed reproductive anatomy 
and physiology worksheets
– Identified contraceptive options and 
demonstrated correct condom use
Reproductive Health
Wednesday
– Second session with adolescent girls
• Theme: thinking about ourselves in 
the future
– 16 returned (73% of previous day 
attendees)
– Brainstormed/set goals: who do you 
want to be in 2, 5, 10 years?
– Small group activity
• Read scenario and discussed 
hypothetical scenario of young 
pregnancy
• Discussed components of a healthy 
relationship
– Presented contraception methods and 
demonstrated condom use
– Wrote letters to future selves
Reproductive Health
Wednesday
– Met with ~ 60 members of a church 
youth group
– Facilitated peer‐to‐peer self‐esteem 
exercise
– Youth who had participated in our 
activities earlier in the week shared their 
experiences
– Recorded individual goals for the next 
two, five, and ten years
– Shared goals with group and discussed 
means and requirements to achieve 
them
• A church leader requested that the 
youth record their goals so that the 
congregation could better know how 
to support them and their 
aspirations  
Reproductive Health
Thursday
– Coordinated a health fair for 
approximately 100 high school students
– Groups of 15‐20 students spent 20 
minutes at each station 
– 2‐3 CORE members staffed five stations
• Myth and facts about reproductive 
health
• Reproductive anatomy 
• Physiology of pregnancy and 
feminine hygiene
• Condom demonstration and 
contraception methods
• Sexual responsibility and condom 
practice workshop with emphasis 
on STI prevention
Reproductive Health
Friday
– Met with ~ 30 mothers inside the local clinic
– Facilitated three activities
• Discussed images in the media, how 
young people learn about human 
bodies, relationships, and sexuality
• Performed a parody of a dialogue 
between a mother and daughter; 
whenever the mother in the skit made 
an incorrect statement about 
reproductive health, the mothers in the 
audience booed and made suggestions 
for more appropriate responses
• Mothers participated in a role‐play 
practicing speaking with and responding 
to questions from their children about 
reproductive health (e.g. what one 
would say when their daughter begins 
to menstruate)
 Nutrition, Hand Washing, and 
Dental Hygiene Education In Isla 
de Mendez, CORE ‘09
 Adult Nutrition

• Met with mothers and discussed

healthy ingredients to use to prepare
meals for the family
• Collected and exchanged healthy
recipes
• Went shopping for nutritious
ingredients with the mothers when the
food cart drove through Isla
 Dental Hygiene
• Collected 1,000 toothbrushes and
toothpaste and donated them to
children in the school and poor
families at the clinic
• For some children, we are the only
source of toothbrushes for the year

Children Nutrition
• Discussed the importance of
eating healthy foods with every
class in the primary school
 Handwashing
&
Germ Education

• Engaged every child in the primary

school in a hand-washing exercise
and performed hand-washing
demonstrations at each of the
health fairs with cinnamon and oil
• Conveyed the importance of hand-
washing and the implication of
germs through a classroom skit
Respiratory Health Study

• Many villagers burn their garbage 
as a method of disposal
• To spur the initiation of a garbage 
collection system with data, we 
conducted a survey collecting data 
about respiratory health of 
children between 5 and 11 and 
possible risk factors.
• We went door‐to‐door to talk to 
parents about their children’s 
health. No identifiers were 
retained.
 Survey Results
• 46 households and 71 children were represented in 
our data
• 25.4% of the children in our sample were diagnosed 
with asthma 
– In comparison, prevalence of asthma in the U.S. is 8.2% 
among all ages and prevalence in Mexico in 2004 was 
only 3.3%
• The prevalence of any respiratory symptom 
including cough, wheeze, shortness of breath, and 
chest tightness in the  past year was 87.3% 
 Prevalence of Moderate-Severe Respiratory
Symptoms Among Children ages 5-11 Years

60

50
percentage (%)

40

30

20

10

0
Cough Wheeze Breathing Chest
tightness

A high prevalence of moderate to severe respiratory symptoms was

observed.
 Adjusted OR
Characteristic N* % with Asthma
(95% CI)
Wood Combustion 48 25.0 1.28 (0.29, 5.57)
Gender (Female) 37 66.7 2.05 (0.59, 7.18)
Marital status of mother 51 66.7 0.73 (.18, 2.98)
Mother’s education level
40 44.4 0.40 (0.10, 1.56)
(more than 3rd grade)
Any moderate-severe
39 72.2 5.01(1.10, 22.76)
respiratory symptoms

Wood combustion for cooking and being female were risk factors for
asthma. Mothers being married and having more than a 3rd grade education
had a protective effect on asthma incidence

% with Moderate-
Adjusted OR (95%
Characteristic N* Severe Respiratory
CI)
Symptoms
Gender (Female) 37 53.8 1.21 (0.40, 3.67)
Disposing garbage by
56 84.6 3.7 (0.90, 15.26)
burning
Asthma diagnosis 18 33.3 4.17 (0.98, 17.66)

Burning garbage and being female were risk factors for moderate to severe
respiratory symptoms.
Other Activities:
‐A school‐wide school field clean‐up
‐An English as Second Language 
Session
 Thank You!
• If you have any questions or would like to 
make a donation to our ongoing efforts, 
please email us at:

yalehealthcore@gmail.com