DOs, students, give free care to thousands in Guatemala
Amy Smith, The DO, April 2005
While many people were heading to the beach for spring break, dozens of osteopathic physicians and medical students, along with dentists, pharmacists, nurses and other health professionals, journeyed to the highlands of Guatemala for a humanitarian medical mission.
During the three weeks from Feb 12 through March 5, nearly 300 volunteers treated approximately 6,000 patients near Antigua, Guatemala. The volunteers treated mostly women, children and the elderly, but they also treated some 250 police officers during a visit to a police hospital. While gastrointestinal and respiratory ailments were the most common complaints, the medical volunteers also treated Mayan Indians for more life-threatening disorders. Some of the patients had never been to physicians before.
The mission was sponsored by DOCARE International, a nonprofit organization that has been bringing healthcare to developing areas of the Western Hemisphere for more than 40 years. It had already conducted a mission to Guatemala in January. Another DOCARE group left for Peru in mid-March.
"This Guatemala trip was the most successful one we've had," says James W. Cole, DO, the dean of the Midwestern University/Arizona College of Osteopathic Medicine (MWU/AzCOM) in Glendale. "We've never provided more care for the Mayans."
Dr Cole and John R. Burdick, PhD, the dean of basic sciences at MWU/AzCOM and at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill, oversaw student volunteers from both schools. Twenty students from the two colleges participated, along with 23 students from the Kansas City (Mo) University of Medicine and Biosciences College of Osteopathic Medicine (KCUMB-COM).
During the trip, Dr Cole, Dr Burdick and AOA Executive Director John B. Crosby, JD, also met with Guatemalan officials. In Guatemala City, they presented Erwin Sperisen, the director of the national police, with two trunks of surgical supplies for the police hospital.
The delegation also met with two members of the Guatemalan cabinet-the vice minister for external relations, Marta Altolaguirre Larrando, and the director of social services, Martha Julia de Zachrisson. The parties discussed the possibility of Guatemala legally recognizing osteopathic medicine. Crosby was encouraged by the response of the officials and hopes to get a proclamation of recognition from the Guatemalan General Assembly. "Even if the government should change over time, we'll have a letter on file to fall back on to ensure we have access to do the work we want to do."
In need of care
"This time more than any other time, we saw people who required emergency care," says Dr Burdick, the president of DOCARE, who was on his eighth trip with the organization. "We saw four or five patients who needed immediate care or they would have died."
Dr Burdick recalls DOCARE volunteers treating a 2-day-old infant who was born at home and whose umbilical cord had been cut with contaminated scissors. An infection developed and quickly turned septic. The child was brought to the convent school in San Andreas Iztapa where DOs and other health professionals were treating patients. Deborah A. Shassetz-Johnson, DO, a pediatrician from Modesto, Calif, quickly realized the newborn needed immediate care, and the baby was rushed 20 miles to the hospital for antibiotic treatment. Twenty-four hours later, the infant was doing much better. Dr Burdick noted that the outcome would have been very different if the DOCARE team hadn't been there.
And thanks to the volunteers, another newborn, who was severely dehydrated, is doing well. "There's no question in my mind that the child would have died if we weren't there," Dr Cole says.
But little things can make a big difference too in remote areas of Guatemala. A pair of glasses can open a whole new world-just ask Dr Burdick, who recalls a man who was treated for vision problems late one afternoon. "I distinctly remember this man who was so grateful he could see that he stopped to shake everyone's hand and say, 'God bless you,' " Dr Burdick recalls.
Lions Clubs International donated glasses for the mission, of which nearly 1,000 were distributed. The Catholic Medical Mission Board donated $300,000 in pharmaceuticals and supplies.
Much of the volunteers' efforts revolved around patient education. This year, technology lent a hand. DVDs played continuously for the people in line, covering such topics as dental hygiene, hand washing, food safety and prenatal care. "It was a step for us to work on preventive medicine instead of just correctional medicine," notes Dr Cole, who was on his fifth trip.
Relying on OPP
Without the luxury of advanced medical technology, the volunteers went back to basics.
"When you don't have all the facilities and equipment you're used to, you make do," Dr Burdick says.
"We had no CT or MRI scanners. You have to use clinical skills and your eyes and hands to diagnose," explains Gary L. Willyerd, DO, the director of medical education at POH Medical Center in Pontiac, Mich.
One ultrasound machine was on hand-and it was invaluable. Dr Willyerd remembers an approximately 9-year-old boy whose parents knew he had a bad left kidney. An ultrasound screening confirmed the kidney was half the normal size and wasn't functioning. It also revealed a large mass, which physicians believed to be a Wilms' tumor. The boy was referred to a hospital for surgery.
Dr Willyerd says relying on basic clinical skills was a terrific learning experience for the 30 interns and residents he supervised from POH and Botsford General Hospital in Farmington Hills, Mich.
"Around the hospitals, they feel they need a CT scan in their back pockets. But here they realize they can't even get an X-ray," he says. "They gain confidence by rekindling skills, and they learn how valuable those skills are."
Because of the shortage of medical technology, training in osteopathic principles and practice proved crucial. Clinical suspicions were confirmed by palpatory diagnosis, and the Guatemalans were treated for musculoskeletal pain using osteopathic manipulative treatment. Many Guatemalan people spend their lives doing laborious tasks. Women often carry water and other goods in baskets on their heads and tote infants in slings, and most men work in the fields.
"They're hard workers," Dr Cole says. "There are plenty of opportunities for providing OMT."
Jeff D. Schroeder, DO, the chief intern at POH and a first-time volunteer, saw immediate relief in the patients. "OMT helped the people to be more comfortable," he says. "So many suffer from neck, back and joint pain. OMT saved them agony and emotional distress and provided relief."
Gautam J. Desai, DO, says that OMT was performed wherever there was space, which sometimes meant using an old hospital bed or the floor.
"The people really liked the OMT," says Dr Desai, an assistant professor of family medicine at KCUMB-COM and a co-medical director for the school's mission volunteers. "They were smiling broad smiles because they could breathe more easily and move their backs."
Changing lives
Providing medical care in Guatemala was an eye-opening experience for the osteopathic medical students on the trip.
Erica A. Horton, a third-year medical student at KCUMB-COM, says she will never forget one of her patients, a man in his early 40s whose body was ravaged by type 1 diabetes mellitus. He had run out of insulin three months before. "His blood sugar was so high it was off the charts," Horton recalls. "He had the worse diabetic ulcers I had ever seen. He was missing toes, but he sat and smiled the whole time." Horton cleaned his legs, not thinking of the stark reality of his condition but of how appreciative he was. "It was amazing," she says.
Horton, who had always wanted to go on a medical mission, says the experience changed her. "I don't think I've learned so much in my entire life. It makes you remember why you chose medicine as a career," she says.
Third-year MWU/AzCOM student Peter J. Taylor, who was on his first trip, spent much of his time educating people about ailments such as diabetes and urinary tract infections. But he was especially moved by the simple interactions with the Guatemalans. "Although education is always my favorite part of the physician- patient interaction, my words in Spanish, few as they are, seemed to go much further," he says.
With help from a DO, Taylor used osteopathic principles and OMT in diagnosing and treating patients. He found OPP especially helpful in distinguishing gastritis from other ailments.
Dr Willyerd says interns and residents were particularly affected by their experiences in Guatemala. "By the end of the trip, all of them had thanked me for making it possible," he says.
Internally, DOCARE has been discussing how it can continually provide care to Guatemala. One possibility involves staffing local clinics with DO residents.
"We're there three weeks," Dr Willyerd says. "I worry about what will happen during the other 49 weeks."
Its own reward
Whatever the challenges-12-hour days, three-hour commutes to remote areas, and transporting medical supplies and equipment-the rewards made up for them.
"Everyone feels good at the end," Dr Burdick says. "We're tired, but we're happy with what we've accomplished."
Dr Cole agrees: "The Guatemalan people are so thankful, it's reward enough for all the expense and work we go through."
"These trips fill your heart and encourage you," says Alan G. Schalscha, DO, the chief resident at St Joseph's Hospital and Medical Center in Phoenix. Making his fourth trip, he began going when he was a third-year student at MWU/AzCOM. "People who volunteer tend to not be selfish, and they tend to work extra hard. Half of the benefits go to the physicians, the physician assistants and the rest of the team." Dr Schalscha says the experience changed his perspective on healthcare back home. "It makes you see how fortunate we are, and you acknowledge the resources and amazing healthcare we can provide in the United States. Healthcare is so different here. At home, we go to a physician when we sneeze. There, they stand in line all day, or for two days, to get vitamins. And they're very happy to have those vitamins."
Taylor recalls the patients' reactions when told the care was free. "At this point, my blessings from God began," Taylor says. "It really is a valuable and beautiful thing that we are doing down here." Dr Schalscha concurs: "Everyone should go. It's so much fun. If you have a heart for it and you want to help, you can help." John Crosby, the AOA's executive director, who was on his second DOCARE mission, is proud of what was accomplished. "If you want to feel good about the future of osteopathic medicine in particular and the medical profession in general, going on a mission like this and caring for patients like these-many of whom had never seen a physician before-is quite inspiring. It's a great learning experience for the students and a great caring experience for the physicians and other volunteers."