AbstractWe describe the efforts of two related undergraduate projects to promote lasting social change in marginalized communities in the Dominican Republic and Nicaragua. The projects represent a test of the premise that undergraduate projects can engage academically based strategies and transcend good intentions to achieve effective community partnerships to improve health and health care. The projects proceed from a perspective and theory of marginalization and its consequences. Specifically, marginalization undermines individual and collective capacity to meet basic needs and efforts to thrive. Through strengthening social infrastructure, communities can overcome the effects of marginalization. Project work begins with annual medical clinics and, with the permission of community residents, team members conduct ethnographic descriptions of the communities and their health and health care concerns and resources. We use social network analysis (SNA) and geographic information system (GIS) techniques to describe social infrastructure. Working from those foundations, both projects have enabled increased social infrastructure. To date, we have observed increased communication among community residents, facilitated the development of community-endorsed five-year plans, and established partnerships with regional and international groups.