Daniel Brewster’s favorite classroom in the world is an empty pool in Esteli, Nicaragua. He studies a photo from that day and tries not to tear up. In the image, it’s a warm night. The students are in shorts and short sleeves. There’s a backdrop of lush, tropical greenery. The pool is dry save for a few puddles, and the light from the buildings around them is dim. Everyone looks bone tired. Not just from whatever labor or traveling they’d done, but from the experience itself. The experience of fully breaking out of the comfortable enclave of campus and into a very different reality. Still, every student is intently listening. Perhaps more so than in any other class they’d ever attended.
“The students are just sitting on the ground in this empty pool. I'm standing, the picture was taken from my back. Fifty students here in front of me who are having an experience that they don't get anywhere else.” As a professor of sociology, Brewster is careful to correct you if you call this a trip. It’s also not just a study abroad. Or simply extracurricular.
Destiny Noel and Nico Muttillo work alongside local residents to improve community health.
The best word for this is an experience — a potentially life-changing one for those students who earn the opportunity. This is the WVU Medical and Dental Brigades. The term brigade is fitting. It’s tactical, strategic, well-organized, and intense. A lightning rod. And for the students and volunteers who are accepted to participate, it’s often a wake-up call. “This is a different type of clinical experience, educational experience. It’s not one that happens in a classroom. I'm not even sure if it happens in a hospital space,” Brewster said. “They're learning a more holistic understanding of health and medicine.”
HUMBLE BEGINNINGS
The parent organization, Global Brigades, started some 20 years ago when a group of Marquette University students, working closely with doctors and local organizations, traveled to Honduras to provide medical care to rural communities. Their model was so effective the students formalized it into a nonprofit that has grown to encompass many other components desperately needed in under-resourced communities around the world, providing things like health education and sanitation. Other universities across the country joined the movement.
Following this life-changing experience, many former Brigaders are practicing or in residencies.
WVU began its own chapter in 2010. But it wasn’t until Brewster became the adviser for both the Global Medical and Global Dental Brigades at WVU that the organization became what it is today. Humbly, he claims there’s no big story about how he became involved almost 15 years ago. “The professor who was advising them left, and they were desperate for someone,” he said. At that time, the University was looking to change its vision of education abroad as a whole. “They wanted it tied to coursework, educational outcomes, and an experience. So, people weren’t just going on trips.”
Brewster got to work developing a course called Sociology of Health and Medicine that became required for all students intending to travel with the Brigades. “Sociology is, by definition, the study of human interaction. So, we look at how human interaction impacts health and medicine. I thought it was really important. Anyone going into the medical field, whether it's medicine, dental, nursing, PA — they could benefit from thinking about concepts like race and gender, socioeconomic class and sexual orientation, inequality.”
And he wanted his students to draw connections between these experiences abroad and what they would face working in the United States.
“What I want to do is to highlight the similarities between places like Appalachia and Latin America. Because it's essentially the same thing, rural West Virginia and rural Honduras — many people have to go to bigger cities to get the best hospitals, the best doctors. People here have to come to Morgantown for the best medicine. It’s just reality that in many rural places there are no doctors,” he said. “Rather than highlighting only the differences, I want to approach both the similarities and differences because I think that helps [students] better understand their patients in the future.”
Students Meg Sorrells (left) and Molly Powney (right) provide critical dental health and education at the dental station.
These patients travel hours, sometimes packed into various modes of transportation, sometimes on foot, to get to the communities where the volunteers set up. Then they wait in line for intake. Students, alongside community volunteers, help gather patient information: names, ages, medical histories, and residences.
After intake, patients move onto triage, where students work with translators to take and record vitals like blood pressure, temperature, allergies, family history, and their chief concerns. A licensed healthcare professional, again shadowed by students, asks each patient additional questions, working out a diagnosis and, sometimes, prescribing medication. Students also help by transcribing information into a local medical database that is shared with other stations, so patients can have better continuity of care.
At the dental station, licensed dentists offer cleanings, fluoride treatments, and tooth extractions. Brigaders can shadow and ask questions and even help children learn about oral hygiene. The Brigades includes a pharmacy station, where medications and supplies are packed and distributed with the help of a pharmacist.
In 2024, the WVU Brigades will add an OBGYN component to cover women’s unique health needs and add optometry to address visual health.
The charla, Spanish for talk or chat, is the educational component of the brigade. Patients of all ages, but especially children, can see presentations on preventative care and personal health. Finally, the public health component involves all brigaders. Students, local masons, families, and volunteers work on projects to improve community health, hygiene, and sanitation; building eco-stoves, latrines, and water filters, water storage, and showers. Educational workshops for schoolchildren and community leaders empower them to take the reins on everything from lifestyle to pollution.
THE RIGHT STUFF
As of December 2023, the WVU Brigades has worked with 16 resource-reduced communities in Central America and Africa, directly serving more than 10,500 patients and thousands more through public health projects over the course of 33 brigade experiences. The group has also helped raise more than $1.5 million in donations.
But it all hinges on choosing the right students. Students like Sandrik Tabidze, a senior studying biomedical engineering and computer science. Hailing from Atlanta, Georgia, Tabidze is the current student president of the medical portion of the WVU Brigades. He learned about the program from his brother, a WVU alum and former brigader himself. The stories his brother shared over Christmas dinner and on summer breaks ignited something in Tabidze. As soon as he arrived on campus as a freshman, he said his first goal was to apply. He’s been brigading ever since.
But the process wasn’t easy. There were multiple essays and interviews as well as successful completion of Brewster’s course, all while navigating the mental, emotional, and physical preparation for the intense eight-day service experience (held over spring break).
“As soon as you get accepted, right off the bat, it’s straight to work. We meet with small groups within the organization, and we practice on our triage skills — blood pressure, temperature, pulse, respiration — and our Spanish skills.” The language component is crucial, especially in Central American nations, in order to meet the patients where they are. “We have to understand that we’re going into an under-resourced region of the world. It’s really important to try to learn the language so we don’t seem as intimidating.”
“ It’s a very holistic model. You're not only practicing your triage skills, but you also get to shadow medical professionals from that nation or region of the world. ”
— Sandrik Tabidze
In January, students begin the course. “That’s really when we dive into the sociology behind medicine, not only in the United States but also in the countries we’re serving,” Tabidze said. “This gives us a unique perspective on why it is that we’re serving this region. What could we encounter? What are the proper practices when we go in there?” He said it’s a balancing act, with the end goal of empowering communities to help themselves rather than a privileged group swooping in to place a bandage and leave again. “The class really underscores that,” he noted.
During the travel component, students operate much like they would in a hospital setting. “It’s a very holistic model. You're not only practicing your triage skills, but you also get to shadow medical professionals from that nation or region of the world,” Tabidze explained. He contrasted this approach with the transactional nature of healthcare in the U.S., where tests often precede diagnosis. In under-resourced regions, doctors must address various factors such as diet, history, and social interactions to develop treatment plans. This holistic approach, Tabidze emphasized, is a key lesson drawn from their experiences with the WVU Brigades.
Brewster also makes sure that the WVU Brigades experience comes full circle — starting and ending in West Virginia. As part of the course, his students work directly with the underserved in Morgantown and Monongalia County through Pantry Plus More, where they volunteer once a month in mobile food pantries, packing and distributing food and basic supplies to those who need them.
“What I want students to recognize is that medicine isn’t something that's just happening in a hospital or in a clinic. Health and medicine are so intimately tied to our way of life, our access to resources,” Brewster said. The students who dive into these experiences, inquisitive and ready to put in the work, are the ones he knows will be successful. “I'm interested in students who are adventurous, intellectually curious, willing to do the research.”
Sophia Flower, a Fairmont native and current president of the dental portion of the WVU Brigades, wasn’t put off by the rigor. A senior in biology and Appalachian studies, she was compelled by the Brigades’ dual focus on communities at home and abroad. “I came to WVU wanting to go to medical school. I have also been drawn to serving rural areas like West Virginia, where I grew up. I really just wanted to connect those two things together, both the abroad experience and those rural experiences here.”
She said, especially during the COVID-19 pandemic, the scarcity of resources in rural West Virginia became even more stark and the work of the Brigades even more important. “Having gone on a brigade previously, it really helped open my eyes to some of the things that are also going on in our own backyard. We see a lot of health disparities in Appalachia and in West Virginia. Food insecurity is an issue all over the world, even here.”
After college, Tabidze and Flower are focused on two different paths, both influenced by their Brigade experience. “When I first attended the University, my plan was to go to medical school and become a doctor. But I think Brigades is shifting that perspective. Now I think I might want to go into law,” Tabidze said. He was inspired by the health and economic disparities he saw both abroad and at home.
Flower, on the other hand, only found her passion for medicine intensified. She plans to start medical school at WVU in the fall. “I know I will be a much better doctor and a better person by going on these brigades.”
A PRESCRIPTION FOR CHANGE
Students who pass through this program are nearly always fundamentally changed, no matter what they choose to do after college. Pranav Jain, another Fairmont native, completed his first brigade a decade ago as a WVU freshman. He was student president of the medical side of Brigades from 2014 to 2016 and returned to the Brigades in 2023 as an instructor of support and a medical support doctor, helping students move through the experience just as he had. And he’s excited to help inspire the next generation.
Student Brianna Hodak forms a bond with a patient at the clinic.
“I remember being in their shoes. It was really in those clinics where I found my love and passion for medicine. What really made me feel this is something I can do for the rest of my life.”
He’s brigaded in Honduras, Panama and Nicaragua and looks forward to heading back to Honduras in 2024, where it all started. From undergrad and medical school at WVU to an internal medicine residency to his last stage of training, a fellowship in pulmonary and critical care at the University of Pittsburgh, Jain has taken his brigades experience with him everywhere.
“My ultimate goal is to take everything that I’ve learned during my training and eventually, at some point, come back to West Virginia to practice. Whether that be in Morgantown or in a more rural part of the state. At some point in my career, I want to come back and try to give back to West Virginia, the state that’s given me so much.”
Brewster has seen many students pass through the program. Every one of them brought something unique to the Brigades and every one took something unique home with them. The impact on communities where the Brigades operate has been gigantic. But the impact on the students, who will go on to become leaders in their fields? That has been an immeasurable good.
“We’re probably closing in on about 450 alums who’ve traveled with me in just the last several years, and we didn’t even get to travel in 2020, 2021 or 2022 because of the pandemic,” he said. He looks back to the photo of his favorite classroom, the empty pool in Nicaragua. Brimming with possibility.
“Some of these students are now dentists. Many of the people are nurses or Pas. I know dozens who are either practicing medicine or still studying excited for residencies to come.” And despite their diverse backgrounds, passions and futures, their collective experiences with the Brigades shaped them into better versions of themselves.
“They all want to do good medicine. They’re interested in contributing, helping, affecting social change — either in their work or in their communities.”
