Team Nicaragua :: Last Night


Today is sadly our final day together as a team here in the beautiful country of Nicaragua.  It began with a humbling devotional time over breakfast that facilitated introspection and reflection on our service for the week.  During the week we have all faced many challenges, both as a team and individually, as we delivered healthcare to those in most need in the rural and remote areas surrounding El Viejo.  We now all have a better picture of the unique model of sustainability that exemplifies PMI – because all of our patient encounters have now seen healthcare providers in their communities and have follow up opportunities at our El Viejo Clinic and a chance to access care at an affordable price!

For now, we’re all headed to Vistamar Pochomil, a beautiful beach on the Pacific Ocean with horseback riding, surfing, ATV tours, beach soccer, pool volleyball, and a little time relaxing in the hammock.  We have all worked so hard this week, with a genuineness in our hearts to reach out and touch the souls of some truly tremendous people in Nicaragua and demonstrate our love for them by providing simple healthcare.  This free day on the beach is so well deserved, and as Team Director, I am overwhelmed with the cohesiveness and camaraderie I have witnessed this week united under a common goal. Everyone has coalesced greatly and formed bonds that I’m sure will endure for a very long time from now.  We are now all a community – part of the “PMI family.”

Our hearts are somber as we ready ourselves to depart and return home.  Everyone here is so loving, caring, and hospitable!  Leaving such a beautiful people is always so difficult – but returning to our families and friends will be comforting, especially as we share this experience and the infectious and contagious spirit of service.  Moving forward, we spoke of “integration,” and how we can take these experiences and feelings back to the states with us and do something positive and constructive with them.  Our week was intense, but this mission trip does not end today…it is with us forever and nobody can ever take it from us.  There is already so much talk of volunteers returning on future trips, bringing friends, bringing family, and spreading the word about our work here in Nicaragua.  Success!  Mission Accomplished!

It’s been a true honor and privilege to serve and lead this team.  Can’t wait for the days when we can all return in service to provide healthcare once again!

Cuide Se y Vaya con Dios!

Evan P.

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Team Uganda :: Last Night

Today we began our bittersweet last day in Uganda with a rousing Safari Trip. The day began bright and early with breakfast at the Masindi Hotel and then off for a two-hour trek to the Paraa Safari Lodge. While driving down the dusty road to meet the barge to cross the Nile, the team wandered upon the ever present baboons that seem to own the roads, many different birds including the stately Ground Hornbill and managed to fend off hordes of insects in what can only be referred to as “Tsetse Terror.” This first leg of the journey ends with a barge ride across the Nile River while multiple hippos look on.

The team then enjoyed a delicious meal at the Paraa lodge and was welcomed with a well-deserved afternoon of swimming and lounging at the pool and lodge where all the rooms overlook the jungle and the Nile. After several hours, the team loaded up the familiar vans and a few added trucks to head out into the Murchison Falls National Park.

The Safari began with the team clambering on top of the vans. The team was able to spot a handful of elephants and dozens of giraffe within the first ten minutes. The next few miles consisted of hundreds of antelope of many different species and incredibly picturesque views of the Congo Mountains in the distance and the Nile River nestled in the valley. Just as we were passing herds of water buffalo, the team was alerted to a lion spotting. We circled around and made our way to a small grove of trees where a mother lion was resting as the cubs played in the brush. Given that seeing a lion is not guaranteed, seeing one so early and still during daylight was quite a treat. It seemed like only five minutes had passed before a second group of lions was spotted. This included two female lions and a litter of at least six cubs. Having exceeded our lion quota, the team raced down to the water’s edge to watch the sunset and see the hippos. The hippos had a private neighborhood cul-de-sac in a secluded corner of the Nile.

This seemingly concluded our Safari tour as the sun was going down and it was well past dinnertime back at the lodge. We climbed back into the vans to head back and not a moment later did we spot a full-grown male lion complete with a glorious mane. While we eagerly took multiple photographs, a female and several cubs came out of the brush to join him as they began to start hunting for the evening. This was truly a sight to see.

The team ended this glorious day with another great meal at the lodge and climbed into bed early to prepare our bodies for the long journey home. We will start tomorrow morning early with a long trek back to Entebbe through both Kampala and Masindi to board our flight to the US. This trip has been an amazing experience and something that will never be forgotten.

– Ryan Maddrey

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Team Nicaragua :: Clinic Day Five

Today was our final clinic day, which was so bittersweet. Our morning began with exploring Romans 8:38, which challenged the team to see Christ’s face in each individual we encounter and to rest in the fact that “neither our fears of today, or worries about tomorrow can separate us from God’s love.” During a moment of silence we were able to reflect on our week and recall to ourselves why we are here. One example is through the personal testimonies and life stories that have been shared each night, allowing us to realize the depth of the challenge of this scripture that calls to us to be obedient. These special moments have allowed us to realize that we are never alone.


Today in clinic, we saw a 149 patients making for a grand total of over 1,080 patients for the week, which is a huge accomplishment. Our team of 50 people has become a family. Our struggle of the heat was not as profound on this last day because we kept our hearts open to the message of God. It was difficult saying good-bye to our translators who we have worked alongside all week, however, we can rest in the fact that the Lord has a plan for them and will remain here to continue doing good work.

The fellowship within the community of Nicaragua has created a sense of determined teamwork within our mission team. Collaboration of the volunteers has been profound. We truly believe our work has left a message in the minds and souls of the great Nicaraguan people. We all know that they are in great need and are truly grateful for our ability to provide sustainable healthcare with open them with open hearts this week. We will certainly never forget this trip and hope to carry our goal of lending a helping hand and showing other’s God’s love for his children wherever we are. As the PMI Medical Director Dr. Ed O’Bryan said, “you don’t have to believe you are the answer to someone’s prayer to be the answer to someone’s prayers.”


With open hearts,


Amy Totherow and Amy Evans

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Team Uganda :: Clinic Day Five

Hello from all of the OT students! Today was the last day of clinic in Kijunjubwa- we can’t believe how quickly this day has come! We were scattered throughout the clinic today with some of us in the therapy room, some in pharmacy, some in triage, and some with the physicians.

The highlights from the therapy group included Angry Baby, Floppy Baby, and Happy Baby. We also saw several patients with Carpal Tunnel Syndrome allowing us to use all of the special tests we have learned in class! Another cool thing about today was that many of us donated our shoes right off of our feet to those who showed a greater need. A group of us made splints in a pot of water boiling over a charcoal fire – much different than what we’re use to at MUSC! Those of us in Triage got lots of practice taking blood pressure, heart rates, and respiratory rates, and the pharmacy girls were able to distribute LOTS of ibuprofen and practice their dance moves in between patients. At the end of the day, Patty and Cindy awarded each PT and OT their own special “message in a bottle” made out of duct tape and used water bottles. The awards ranged from Little Miss Good Attitude to Little Miss Hemorrhoids.

We invited our local staff and partners back to Masindi Hotel for dinner. There were a plethora of vendors awaiting our arrival with locally made goodies including clothing, artwork, jewelry, quilts, and so much more!

Our last day in Masindi ended with surprise entertainment from a local dance group who performed a variety of traditional dances, and then invited us to join in on the fun! By the end of the night, we were all dancing African dances, wearing African skirts, and “shaking what our mothers gave us” as described by one of our interpreters.

We’re sad to be leaving Masindi, all of the wonderful patients that we’ve seen, and all of the other amazing people we have met this week, but we’re so excited to head across the Nile River for some safari fun! We miss and love you all, and can’t wait to tell you more details about this experience.


The 14 OT girls

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Team Nicaragua :: Clinic Day Four


Today was a great fourth day of clinic! We traveled 50 minutes to a village in Tonala, Nicaragua where we saw 212 patients in a local church. We continue to be humbled each day with the number of people who are in need of quality healthcare. We saw a variety of conditions, ranging from childhood asthma to diabetic foot ulcers.

It was the first day this week where the team really seemed to come together as a single unit. It has been a tough week thus far with the heat and the number of patients we are faced with each day, but we continue to coalesce and support each other on this spiritual journey.

We had a plethora of shining moments where team members used their individual skills and passion to deliver extraordinary care to the people of Tonala. These moments ranged from helping patients overcome physical therapy obstacles, to joint injections, to minor foreign body procedural removals. None of these tasks would have been able to take place if we did not have our amazingly talented translators who never cease to astonish us with their hard work and caring personalities.

Today we had to say goodbye to a vital member of our team, Dr. Ed O’Bryan. As the cofounder of PMI he represents the values, beliefs, and morals that embodies the foundation of this great organization. As physician assistant students at MUSC we never imagined that we would be lucky enough to not only learn from the best, but actually work alongside a physician with as much experience and passion as Dr. Ed O’Bryan. And of course you cannot forget his sense of humor and infectious laughter that proves to us that no matter what we decide to do in life, it should bring us joy and happiness each and every day.


Halie Shipley and Ashley Barrera – PA student team

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Team Uganda :: Clinic Day Four

Today was a great fourth clinic day! We traveled 45 minutes to a village which will soon host the next PMI healthcare facility. It was great to see the new space and the line of patients affirmed the need in a very tangible way.  We saw a variety of things ranging from seasonal allergies to paralysis.

We did not see as many patients as in previous days, but it gave us a chance to play with the children, take pictures, and really get to know the people we were serving. One of the things we have been realizing is that numbers do not always matter. Sometimes it is better to take our time and really provide the highest level of patient care. Customer service and good patient care is something that is not very common in this part of the world but the local staff at MKMC is working really hard to bring about change in the way Uganda does healthcare.

We had a lot of great moments, but one that sticks out is when a team member named Jake sang Jingle Bells to the children and they all danced along even though they had no idea what he was saying. We also got to know the security guards who have been working with us all week. We were happy we got to hear their stories and that they were able to see the doctors.

It was a shorter day than usual, which was a nice break after such a long day yesterday. We were thankful we got a chance to relax and have a nice dinner where we shared shout-outs and life stories. The week is flying by and we can’t believe tomorrow is our last clinic day. It’s bittersweet but we look forward to serving more people in the community!


Maddie and Crockett

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Sustainability: Moving from Buzzword to Lasting Change

By, Michael O’Neal, PMI’s Director of International Projects

Recently, I had the opportunity to present at the Global Health and Innovation Conference at Yale University about the idea of sustainable healthcare. So often, sustainability is used in the development field as a buzzword to get people’s attention however, through its popularity, sustainability has been diluted into a word that means anything from consistent cash flow to creative assets. But here at PMI, we have actually seen sustainability work. To us, the term sustainability has lost its focus on the true objective. We believe that sustainability means lasting, community forged change and we’ve experienced the effects of this change firsthand in Masindi, Uganda.

The Problem: Access to Healthcare

Access to healthcare is a global problem, but in the developing world it is an epidemic. Generally, families have two options, public or private healthcare. Unfortunately, public healthcare in the developing world is underfunded, overcrowded, and unable meet the needs of the community. Conversely, private healthcare is available but unaffordable for close to 90% of the population. So how do you create change for all the families caught in the gap between an underfunded public system and an unaffordable private system? At PMI, we strive to create quality, affordable healthcare to people in need. In Masindi, we have seen tremendous results. Since 2011, 98% of our patient population have been able to afford their healthcare services in full.

The Solution: Finding where Quality Intersects with Affordability

PMI’s clinic in Masindi has successfully found the sweet spot that so many in the development field are talking about: where quality healthcare intersects with affordability. In 13 months, our clinic began seeing over 1,000 patients a month and 100% of the costs were being covered by revenues generated by those patients. “Sustainability,” if you will, has been achieved. This success has allowed PMI to utilize our resources, donations and partnerships elsewhere to invest in new clinics throughout East Africa and Central America, while our clinic in Masindi continues to independently grow and offer quality, affordable healthcare to the community.

The Future: Creating Scalability

So where does PMI go from here? It is our mission to create scalable projects throughout the developing world. PMI exists to invest in local communities, empower people throughout the world to take ownership of their healthcare and provide measurable outcomes that make a difference on a large scale. It is our aim that long after PMI is gone, these quality healthcare clinics will be fully operational and continue to serve their communities for decades to come.

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Team Nicaragua :: Clinic Day Three



In the words of our dear friend Charlie, “Que pasa, amigos y familia?!” For you Americanos out there, that means “What’s up, friends and family?”

We have reached the midway point of our trip and today was our biggest day yet! We saw 252 patients, which adds up to a total of 668 for the week. We started early, ventured out past our neighbors, the fish factory, and ended up at an adorable primary school in Monte Rosa. We were greeted by a throng of eager schoolchildren and allowed a little time for some volleyball before getting the clinic day started.

One of the highlights of the day was watching our PT/OT friends give some incredible wound care, provide invaluable mobility restoration to stroke victims, and even help a little boy with muscular dystrophy walk for the first time, all in 108 degree weather with no fan…thankfully, the “farmacia” got sick of their stench and managed to find them a fan amidst the chaos!

Also, in the provider room today: Dr. Cristin Adams treated an entire family with bacterial throat infections and gnarly skin rashes, Dr. Ed O’Bryan showed a pregnant mother her 11 week old baby for the first time using our handy dandy portable ultrasound, and Catherine, one of our brilliant PA students, saw an unfazed patient with large scorpion sting *gasp*. Needless to say, it was an interesting day.

However, we spent most of our day doing a little behind the scenes action. I (Katy) spent the morning providing reading glasses to people of all ages. Something that may seem so simple to us, like reading glasses, proved to be a transformative experience for my friends here in Nica.

My blog partner and roommate, Laura Jane, had an incredible day in the pharmacy, filling hundreds of prescriptions while keeping her cool and demonstrating her extensive knowledge of medicine!

Anyway, it was an awesome day, but we are ready for bed (and our thirty blog time limit has expired). Buenas noches!!

Laura Jane Baker and Katy Hallman – Team Pharm

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Team Uganda :: Clinic Day Three

An astounding thought is the fact that triage may be the first interaction a patient has had with a healthcare provider during their entire life. The patients from this region of Kisansiya place incredible trust in this person triaging them, without questioning their ability to heal them. This moment is a vulnerable one. Probing questions with revealing answers will hopefully lead to a small – or big! – improvement in health, giving them hope for leading a more fulfilling, productive life.

At many times, we don’t have all the answers, but we do what we can. Even though we cannot follow up with these wonderful Ugandan patients as we would like to, we can offer them our best care in the present moment we have with them. We can listen to them and give attendance to each unique voice as it presents in front of us. Whether in physical/occupational therapy, provider care, pharmaceutical counseling, or the initial point of contact in triage, we can offer them a chance to be heard.

Today was challenging – expectations of both patients and our team were unable to be formed at the start of the day. The long ride back was highlighted by a fiery sunset over Lake Albert, giving us each a moment to reflect on the beauty of the day and these remarkable Ugandan people who are impacting our daily perspectives.

We’re continually encouraged when remembering our faithful supporters back home!

Much love,

Rachel and Megan

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Team Nicaragua :: Clinic Day Two


We were off to an early start today after a scrumptious pancake breakfast at Los Volcanes Hotel. We traveled an hour by bus to Asserradores, where we set up at a church, Iglesia Apostolica de la Fe en Cristo Jesus. Pastor Miguel Perez had been advertising our arrival to his congregation, thus we had an eager group of men, women, and children awaiting our arrival. Triage and the providers set up inside the church, pharmacy was at the pastor’s home next door, and PT/OT was out back under a thatched hut.

Today we were a clinic unlike any other: pigs, roosters, and chickens were running amuck! The clinic flowed very smoothly as we tweaked a few things we learned from yesterday. Evan had challenged us to see the face of Christ in each one of our patients, and his words were evident in the incredible moments of laughter, healing, and big smiles from both patients and providers. From children listening to their own heartbeats in triage, to patients getting massages and fitted for new sneakers, the energy was high! A woman saw her baby for the first time via ultrasound, and a man was fitted with a foot brace after a stroke had left him debilitated. We also treated many patients with derm, dental, and eye ailments. We even saw a more tropical disease, Chikungunya!

The entertainment highlight of the day included Samuel’s coconut opening skills (fruit ninja, anyone?) and watching our translator climb up the mango tree to bring us down fresh fruit. Yummy! Overall, we treated 214 patients! We ended our clinic day with a short trip to the Pacific Ocean where we were treated to an incredible Nicaraguan sunset. Our love for this country and its people is growing stronger with each passing day! We can’t wait to see what the rest of the week brings!

Con mucho amor (and much love!)

Alex and Grace

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