UCSF Students Form Nonprofit to Improve Health in Nicaragua

Four years ago, Noah Hawthorne and Kris Coontz found each other through a “housing wanted” spreadsheet for entering UC San Francisco medical students. 

They formed a lasting friendship and something else that bonded them: a nonprofit dedicated to improving health care for people in Nicaragua. 

Teach for Health is built on community organizing around health. So far, the international development organization has trained 143 health promoters in San Ramon, a coffee-farming region of Nicaragua, and has attracted about 25 U.S. volunteers from the health professions, mostly from UCSF.

The two roommates, who both also have master's degrees in public health, graduated from the UCSF School of Medicine on May 16. Hawthorne will stay at UCSF and do a residency in emergency medicine. Coontz is leaving in June to become an internal medicine resident at Tulane University in New Orleans. But their involvement in Teach for Health will continue.

“The questions we've been asking and the model we've been developing are very much a work in progress,” said Coontz, 32.

Projects are many and varied. They include community cleanups, a vaccination clinic, insecticide spraying for malaria and dengue control, trash disposal systems, health education campaigns, the relocation of kitchens away from sleeping areas and improved smoke ventilation, and day care for the children of farmers.

Bringing Experience on the Ground

When Hawthorne and Coontz met, they already shared a strong interest in global health, as well as international experience on the ground.

“We had a lot of ideas about how things should work, as well as mistakes and pitfalls we wanted to avoid,” said Hawthorne, 29. 

He had entrepreneurial experience as a professional photographer with his own business, and he knew about website development and project planning. Coontz was well versed in global health literature and had been involved with a previous nonprofit in La Pita, Nicaragua.

Both were convinced that a one-size-fits-all approach does not work — and that bitterness, cynicism and lack of trust will result whenever development is used as a blunt tool. 

“When NGOs have been coming and going for years, people get survey fatigue,” Hawthorne said. “They'll say, ‘What's your thing? What are you bringing? Are you a stove person, a refrigerator person, a well person?'”

“And then NGOs think they're just takers — because they're not thinking about the development milieu in which they're working,” Coontz said. “But if you're open and start talking to community members, you'll find out they have a really deep critique of development in the region, and are able to articulate why these development practices don't work. All the clever ideas that are being thrown around in classes on international health and global development — communities have had them first.”

Important Lessons in Building a Nonprofit

Coontz and Hawthorne decided to go beyond the rhetoric of empowerment and have a positive alternate vision, which they would continually test to see if it worked. 

One mistake Coontz and Hawthorne made was trying to keep a low profile, not fully appreciating how suspicious local people would be of their motives.

“They didn't have faces to associate with the nonprofit," Coontz said. “People wanted more branding and they wanted to know us better and what we believed.”

Hawthorne said another issue is tied to using volunteer labor on both ends — the students from UCSF and elsewhere and the health promoters being trained in Nicaragua, who receive only lunch and bus money.

High turnover has been a surprise. Coontz said they now consider it a success if someone volunteers for a year as an active health promoter.

“Our big struggle is working on incentives to promote efficient program development and volunteerism," Hawthorne said. 

He said the ideal health promoter is already a community organizer, who will benefit from the specialized training and networking that Teach for Health can provide.

“We're trying to be a catalyst to help people already doing good work,” Hawthorne said. 

Designing Projects that are Desired and Needed

The roommates most recently visited Nicaragua in April, for a health fair in San Ramon designed and organized by health promoters. More than 200 people came, and over 100 health screenings and Pap smears were done. It also served as a community-building event that showed off some remarkable creativity — there were songs, plays, dances and poems about health.
 
One group made a CD to be used for fundraising. A few lyrics from a song called “La Mision”: Joyful will be the people / Sharing without end / That which Teach for Health / Came to us to teach.

Teach for Health, which relies heavily on micro-grants, recently hired local people to fill two new staff positions — development coordinator and program coordinator — and has ensured that a Peace Corps volunteer will be permanently assigned to the organization.

The basics — first aid, triage, health education and community mapping — have been easy, Coontz said.

“But our ambitions are greater: To help health promoters act as consultants in their communities and design a series of projects that are truly desired and needed,” he continued. “And that's where we find ourselves now — on the brink of getting these projects to go by themselves without being too top-down.”

Photos by Noah Hawthorne