Reflections on DOCARE Experiences
Since 1961, DOCARE has run hundreds of trips involving thousands of volunteers and patients. This section of our website is dedicated to some of our DOCARE member’s personal stories of the people met, the work done, and sometimes even the lives saved. Contact us if you’re a volunteer with a story to share.
In August 2022, DOCARE member Codey Pedersen, DO PGY2 from Kingman Regional Medical Center, traveled with MSUCOM IGH under leadership of Gary Willyerd, DO.
PERU – As an EM resident starting my second year of residency it is sometimes easy to forget the amazing job we get to do and how lucky we are to be afforded the opportunity to help people and practice medicine. However, my trip to Peru only made possible by DOCARE had a recurring theme that was a simple word and reminded me how lucky I am to be given this opportunity as a physician. That theme word was Grateful…
That was the word that kept going through my mind and was the common theme throughout my two weeks in Peru and in the Amazon. Not only was I grateful for the healthcare and resources we have in the United States and the conveniences we have, but I was more in awe of how grateful the Peruvian people were even with their relative lack of resources and how grateful they were for us to be there, trying to help.
As someone who has not traveled much and on his first medical outreach trip what an amazing experience it was to fly to Iquitos, Peru, the largest city in the world that you can’t drive to; as it is only accessible by boat or plane, to help treat the local people. During our trip we were armed with only point of care glucose, hemoglobin, blood sugar, urinalysis and ultrasound and we saw over 1200 patients.
Our days started with thirty-minute bus rides to start seeing patients by 8AM. On the drive we passed countless “Tuk Tuks” the most common form of transportation in the city, and got a glimpse into their everyday commute.
The first few days of our outreach we set up in a local church where a Peruvian priest that trained in medicine in the US now serves his patients and parishioners. We spent each day seeing patients with multiple specialists available ranging from OMM to Neurology and Urology, and I worked as a general medicine doctor treating patients. Some were there for emergency care ranging from acutely dropping hemoglobin’s to ACS, which we triaged to the hospitals for further emergent care, and some were there to see a doctor for the first time in their lives for a full checkup.
Among the innumerable undiagnosed diabetes, cataracts and hypertension we also saw patients with untreated elphantitis, cleft palates, hypospadias, and parasitic infections. We were only able to prescribe antiparasitic, antibiotics, metformin, tylenol and ibuprofen and yet even with those minimal resources the patients were just happy to have people that cared for them and willing to listen to their health care needs. Many told us that they had woken up at 3AM to be in line by 3:30 just to see us, as they knew that we could help them.
The final two days we went to a local hospital and continued to see patients and help in whatever way possible. I spent hours speaking with patients about little lifestyle changes they could take to improve their health and chronic problems on top of the medications we could provide.
Outside of us seeing patients we also had the opportunity to visit local shaman on the amazon and learn their holistic ways and how they work with what the amazon has provided and create medicine ranging from anti-inflammatories, and antiseptics to antiemetics and antihypertensives, using nothing but mixtures of the plants and natural resources the amazon has to offer.
Beyond medicine, being immersed in the Peruvian culture was an amazing experience. From the food to the music, to the cities and piranha fishing it was amazing to learn of their history, learn how they live and the traditions they follow and be a little part of their lives. The experience of traveling to Iquitos will stick with me for life and I cannot wait to get back to offer more help and to help treat the wonderful people that live on the amazon. I am so grateful I was given the opportunity and support of DOCARE in order to help make this trip a reality.
Travel the Distance Your Patients Need
In February 2020, Cory Birkestrand, OMS IV, traveled to Guatemala with KCUMB.
GUATEMALA – In 2012, my worldview drastically changed and has since continually expanded due in large part to the endless global opportunities my alma mater strongly promoted, where nearly sixty percent of undergraduate students studied abroad prior to graduating. While my first study abroad experience focused on field ecology research in Costa Rica, it lit an internal flame leading me to participate in another study abroad opportunity the following year, this time studying public health in Botswana. This exposure to public health in a country that was still afflicted by the HIV/AIDS crisis that began in 1985 paved the way for seeking a medical education where continued pursuit of public health outreach was feasible. Kansas City University combined my three related career aspirations stemming from my undergraduate studies: pursuit of a medical education, global health outreach opportunities, and bioethics. Flash-forward and it’s February 2020, mere months away from graduating, and I was blessed with being able to be involved in a global health opportunity in Guatemala; a component of my professional medical journey I hope to continue during my residency training.
1746. That is the number of Guatemalan and Mayan patients helped medically over the course of eight clinic days at eight different municipality locations by 39 third- and fourth-year medical students who were accompanied by physicians familiar with global healthcare needs. Patient care ranged from obtaining health history and performing physical examinations to more extensive workups and treatments involving diabetic and pregnancy testing, various chronic pain joint injections, obstetric and gynecologic examinations, and osteopathic manipulative treatment, otherwise referred to as masaje (massage) by the locals. Additional services provided included nutritional counseling and psychological evaluation for anxiety, depression, and other mental health concerns. Such as was the case with a young female patient of mine who was enduring emotional abuse from her former husband which prompted the need to teach her coping mechanisms while providing positive feedback by letting her know she did nothing wrong, a clearly impactful statement as her eyes welled up and tears start rolling down her cheeks.
On a more cheerful note, we had the opportunity to give away baby egg-laying chicks so our patients could have a future source of protein to combat malnutrition as well as help them develop an additional source of income by selling eggs they or their family don’t consume.
While we offered a fair amount of medical services, our ability to provide the best care possible was not without difficulty. One of the biggest barriers to providing quality care was simply due to linguistic challenges, a common issue encountered by international outreach programs but is also a growing challenge even in the United States. However, despite this challenge we were equipped with technology to aid in breaking down this barrier as well as access to a translator. At the outset, personally speaking, my Spanish was rather rusty despite spending three years in high school with an additional year in college learning Spanish which was quickly restored to my surprise and reinvigorated the utility of being fluent in another language. Afterall, one of our strongest skillsets as healthcare providers is being able to listen to our patients keenly while discerning key information from what our patients tell us in order to develop a proper treatment plan.
Reflecting on my new role as an international healthcare provider and our impact on those we served, I found it interesting how the vast majority of patients we cared for were women, mirroring similar trends in healthcare usage in the United States. Certainly, the men in the community would also benefit from being evaluated by one of our healthcare providers; of those men who did seek care, they tended to be skewed towards the older end of the age spectrum. While I do not have an answer for this phenomenon which is likely multifactorial, but unlike the changing patriarchal system in the United States, this system appears to be prominent in Guatemala and may account for the low usage by men as they may be working away from the home and unable to leave work. If true, then it is also conceivable to envision the relative ease of young females to obtain medical care while obtaining healthcare for their children purely out of circumstance in that women in patriarchal societies are typically found to have a more significant role in raising children and if the child needs medical attention it is not a stretch of the imagination to see why women are more easily able to and feel more comfortable seeking medical care for themselves.
As I alluded to earlier, one of my other interests is not only in the study of but the practical use of bioethics in my future career as a physician. Arguably, a major driving force behind all global health outreach programs is the mission to tackle the challenge of healthcare inequality where basic medical needs are often addressed by these programs in poverty-stricken areas with limited to non-existent care. Naturally, when international aid is provided in this manner, ethical concerns undoubtedly arise for several major reasons: long-term impact, continuity of care, ability for follow-up, and resource allocation just to name a few. Certainly, from a superficial perspective a once-a-year eight-day medical outreach trip would not be impactful in the long-term. For example, patients requiring continued follow-up monitoring of their blood pressure or diabetic status are only prescribed a one-month supply of medications which does little to mitigate the long-term implications of these or other chronic conditions if they were unable to obtain future prescriptions. How is it then that the financial costs of conducting such a healthcare outreach initiative justifies the care we provide? Simple. Unlike some organizations, DOCARE International is committed to providing continuity of care by having other affiliated groups travel to the same municipalities on a monthly basis so patients are able to obtain their chronic medications and have their other healthcare concerns addressed. Furthermore, to bridge these concerns, DOCARE International has established clinic partnerships in Tecpán and San Andrés Itzapa to ensure patients are able to either receive free or low-cost year-round care or can be referred for more specialized care in Antigua. However, this blog is not intended to solely address ethical concerns that sometimes plague international outreach programs but illuminate them while highlighting my experiences and thoughts about providing healthcare in an underserved and culturally distinct setting.
In closing, Dr. Paul Farmer, an global health icon and founder of Partners In Health, is quoted in his must-read biography Mountains Beyond Mountains, “if you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others, and the idea that some lives matter less is the root of all that’s wrong with the world.” I am grateful for this opportunity to further my passion for providing international healthcare no matter the distance we had to travel to help address the various healthcare needs of the communities we served while improving my cultural awareness and Spanish speaking abilities. I highly encourage any prospective or current medical students to consider engaging in international healthcare opportunities so that you may travel the distance your patients need.
How 18 Days in Kenya Changed My Perspective of Medicine Forever
In July 2019, Samantha Baxter, OMS-II, traveled to Kenya with KCUMB.
Participating in an international outreach trip as a medical student who just completed her first year seemed a daunting prospect at first. Pathology had barely been introduced into our curriculum and pharmacology was as unfamiliar to me as a foreign language. I worried that I did not have enough of a knowledge base to be very helpful to the people of Masara, Kenya. Armed with my physical exam tools and a suitcase full of medications, I joined eight other students at the Bonyo’s Mama Pilista Clinic to help serve the community to the best of our ability over the course of our 18-day stay in Kenya.
After arriving in Kenya, we were struck by its beauty and the kindness of the people welcoming us to their country. The lifestyle was so relaxed that it gave us a chance to adjust without the pressure of overcoming jet lag. Our first day at clinic was a Monday, giving us a few days to review our exam skills and OMM treatments that might be useful for the population of patients we would encounter in the upcoming days. The excitement of being able to work with real patients kept me from sleeping the first few nights. I could hardly believe that in a few short days I would be able to make a difference in the lives of the people around me. As an osteopathic medical student, I was acutely aware of the differences in culture between myself and those from Kisumu, and therefore tried to soak up as much Luo (the local dialect) as possible before my first day. Morning runs to Lake Victoria gave me a chance not only to keep myself well-rounded but also the rare opportunity to glimpse locals at their jobs and the natural beauty of a lakeside city.
The thing that struck me the most about my time in clinic was the simple victories that medicine affords not only the providers, but also the patients. Every day that we saw patients was the opportunity to make a difference in someone’s life. Over the course of our trip, we welcomed over 500 patients. The experience that stood out to me, was an older woman who came in too weak to stand. A neighbor who spoke English sat by her side, patting her hand and translating back and forth as I asked her about her symptoms and performed my physical exam. The simple kindness this neighbor displayed spoke of the strong bonds present in the community. My patient had collapsed outside three days before and had since been unable to eat or drink anything. All her symptoms pointed to malaria, so I admitted her to the clinic after her rapid test came back positive and helped the nurses start her on fluids and treatment. The next time that I saw her was the next morning as the nine of us were completing rounds with the doctors, nurses, and clinic director. Where she once was quiet and barely responsive, she turned to survey all of us from her cot. I asked her, with the help of a translator, if she was feeling better. She took my hand and told me “I feel much better. Thank you so much for helping me.” Those simple words were the greatest gift that I could have asked for. Later that day, my patient was up and walking and came to sit next to me during a short break. A translator helped me to understand more about her and her daily routines. The emphatic gesturing during her stories and the bright smile she wore warmed my heart. A day before, this woman was barely able to lift her head in response to my prompting, and now she was telling me about her family. Like many people, I chose to pursue a career in medicine from a desire to help others, but up until this point I didn’t realize just how large an impact doctors can have on their patients. What seemed like a simple solution to a clear problem to me made a world of difference to her. That experience is one that I would not have been able to have if I hadn’t chosen to go on an outreach trip with DOCARE.
At an opportunity to attend church in Masara we were introduced to the community. The welcome that we received and the gratitude we were shown demonstrated how important this mission was to them. Some of the members of the village would not have been able to receive care without these trips to the clinic. I walked from the church back to the clinic hand in hand with some of the local children, a few of which I had treated myself. Their excitement to show me their games and houses made me smile and appreciate my surroundings even more. These were real people, with real problems, that came to the clinic at their lowest asking for someone to help them. Each day we shared chapati and tea for lunch with the translators and learned about their hopes and dreams. Every experience in the village and the clinic taught me to appreciate the patient as a whole person in a way that I am not sure I would have learned without the opportunity to take this trip. I learned the importance of a kind word and gentle touch to make a connection with someone who is scared and doesn’t understand what is happening to them. That kind of experience can’t be taught. It is part of the art of medicine.
I am eternally grateful for the opportunity to participate on this mission to Kenya. My perspective was forever changed by the small difference in the lives of the people of Masara that nine American students were able to make. Though I have always been interested in global medicine and outreach programs, I could not have predicted what a profound change it sparked in me. I learned the importance of meeting your patients halfway and treating them not just as a case, but as a unique individual. The necessity of working as a team with limited resources brought all of the student doctors closer together and demonstrated how a unified approach is invaluable to medical care. It is my hope that I will one day be able to return to Masara as a practicing physician and be able to once again donate my time and skills to help the wonderful members of the village and community of Masara.
If You Take The Time to Listen to Your Patients, You Will Truly Gain Their Trust
Mohammud Hashir, OMS-III, shares his experience participating on a global health outreach trip to Kenya with KCUMB.
After 3 long layovers, no sleep, and more than 40 hours of traveling, our journey from Kansas City to Kisumu, Kenya was complete. We had finally arrived at the place my peers and I would call home for the next 3 weeks. I will admit, I was hesitant signing up for this trip; it was going to be unlike anything I had done before, and I am not someone who usually likes change from my routine. However, that timid feeling vanished soon after we arrived in Kenya. Being a Pakistani-American, I visited Pakistan many times growing up to visit family members, and my first impressions of Kenya drew a lot of parallels with my previous experiences in Pakistan. Seeing cows roaming around in the middle of streets and hearing the sputtering motors of “Tuk-Tuks” or Rickshaws, reminded me of all the times I went to Pakistan to visit my grandparents. It brought a smile to my face, and surprisingly I felt right at home.
A few days after our arrival in Kisumu, we had our first day of clinic. I was excited to get started but, understandably so, was also a little nervous. Dealing with a completely different patient population in addition to learning to navigate the language barrier was something I had never experienced before, and as a third-year medical student, this would be yet another challenge in a clinical setting that I had never faced before. But after my first few patient encounters, I quickly realized that these patients, despite experiencing different circumstances, have the same aches and pains as people back home.
Some of these patients hadn’t received proper healthcare in years. Just like the patients I see in America, these patients, more than anything, just hoped someone would tend to their needs and take the time to listen to the issues they were having. I remember one patient I spoke with came into the clinic agitated, understandably so, as he was having considerable testicular pain. Extensive conversation and examination determined he had a significant testicular mass. After discussing our findings with the patient, despite the seriousness of the situation and how worried the patient was, he constantly told me how thankful he was that I took the time to help him and listen to him. He specifically mentioned how he would return to the clinic soon just to see me. In the grand scheme of things, I didn’t do much in terms of treating his condition – he had a significant mass that we could not do anything about in the clinic other than refer him to a larger healthcare center. But his reaction of such pure gratitude was something that really stuck with me. Something as simple as being able to effectively communicate with the patient made him feel like he had a voice that was being heard, and at least made some sort of positive impact.
Every day on our drive to clinic, we would see the hustle and bustle of everyday life in Kenya. We would pass markets full of people buying and selling goods, from fruit to knockoff Nike shoes, busses of people going to work, and students in uniform walking to school. In the village where Mama Pilista Clinic is located, we would pass rice fields full of workers and barefoot kids running around playing on dirt roads. It was a constant reminder that, everyday there is a whole other side of the world that lives their life completely differently than what we are accustomed to. Although they were doing labor intensive work in scorching heat, everyday these workers and kids exuberantly waved at us as our vans passed. I think what surprised me most about my trip to Kenya was how happy and grateful people were. Some of these people did not even have the basics of life that most of us from more developed countries are privileged to have on a day-to-day basis, and yet they were always so happy and full of life. One of our clinical faculty mentioned to us that there is no word for “stress” in the native language of that region. I found that to be fascinating. In clinic, people came from miles away just to receive treatment from “foreign doctors”. They were always so appreciative and respectful, even if they had to wait hours to be seen. They were honored that we came to their country to help them and their loved ones. Their faces would beam with joy as I attempted to speak a few phrases of Luo or Swahili in my strange foreign accent. The kids we met at the clinic were always so lively whenever they saw us, eager to make new friends or get their picture taken. I thoroughly enjoyed speaking with the translators, who were young adolescents either in high school or college. You quickly realize that these are just normal kids who go through the same, regular teenage issues we all went through. We talked and joked around about “girl troubles”, or who was a better soccer player, Ronaldo or Messi. Most of them said Messi, though I’d have to disagree. On our last day of clinic, everyone was sad that we were leaving. Although we had only spent a few weeks there, the rich, impactful experience we had made it feel like our visit had been much longer.
Overall, what I learned most from my experience in Kenya reinforced what I have already learned so far in short my medical career: if you take the time to listen to your patients, then you will truly gain their trust. At the end of the day, we human beings are all built the same; all require the same fundamental basic needs of life, and healthcare is one of them. No matter where you go in the world, people need proper healthcare. And it is this universality of medicine that fascinates me and is one of the driving factors that led me to pursue this field in the first place. As a physician, your duty is to serve those in need, whether it is people in your local community or those who are abroad. I am honored to be have been able to serve and meet the people that I did in Kenya, and I hope that I was able to make even the slightest positive impact in their life. Our time in Kenya was short, but the memories, however, are endless and something that I will cherish forever. I hope to and can’t wait to go back!
Travelling is Learning
Up, up and away we go: Guatemalan Ascent
Thanks to the generosity of Arizona Osteopathic Charities, in February 2019 DOCARE supported Carolina Espindola Camacho (OMS IV, ATSU-SOMA) to participate on a recent trip to Guatemala under the supervision of Dr. Grace Stewart. Carolina kept a detailed account of her experience. See her blog post below.
In preparation for my trip to Guatemala, I needed to review topics that would be helpful to know in-country. I reviewed things such as: prevalent health conditions and daily life struggles impeding the achievement of health.
I joined DOCARE 4 years ago for the opportunity to provide care in places where healthcare is limited. As excited as I was to start my trip, the airlines were not complying; 4 out of the 11 participants got stuck in the U.S. for one day. I was one of the unlucky 4. This delay did not allow us to prepare logistics for the upcoming week with the rest of the team. However, while the rest of the team prepared everything in Guatemala, the stranded 4 practiced Spanish and discussed the health problems and limitations that we might encounter there. One of the physicians was stranded with us. He went on the same trip last year and was able to prepare us for what was coming.
A day behind, but we were eager to get to the rest of the team and start working. We started travelling while the rest of the team in Guatemala – Los Robles prepared all the items to be used during our first clinic day. They did everything from bagging needles, to organizing medication, and recording medical.
We finally arrived in Guatemala, however, we had to wait for transportation to Los Robles. Meanwhile, we walked around our hotel in Guatemala City and ate some local food to save up energy for the upcoming weeks.
This was the first day of many amazing ones. We traveled three hours and many miles, to arrive in Los Robles. I barely said hello to our classmates and professor. There were many patients to see and we all began to work immediately. Even though we did not receive the same training as the others, we followed and succeeded in keeping the rhythm and flow. Everything ran smoothly despite the unexpected travel delays.
Some of the patients came from far away, wearing their nicest clothes, if possible. Many of them had acute problems such as upper respiratory infections or impacted ears. We helped an elderly patient with an impacted ear. We even did a home visit to someone who needed attention, but could not come to the clinic due to lack of transportation and a recently amputated leg.
It was incredible the number of people we saw in one day. We saw about 100 patients of all ages, suffering with health issues ranging from UTIs, diabetes, diaper rashes, to osteoarthritis. We treated and most importantly educated every single patient about their health, health maintenance and lifestyle.
We finished seeing patients after 5pm and then we organized everything for the next day. After a light delicious meal, we debriefed and discussed the things that we could improve in our work and the things we learned. This was an amazing first day and I was looking forward to the next day.
This day we visited a new location, never before visited. There was some nervousness since no one knew what to expect. After a bumpy trip through rural roads, going up and down mountains, and through small communities, we arrived.
The clinic was nicely-built clinic and seemed well equipped. Nurses and a doctor come once a week. They were equipped with assistants who mostly spoke Spanish and Quiché (K’iche’). The interpreters were a major asset in this community because many of the patients did not speak Spanish.
We were well equipped from the beginning since everyone was in attendance from the start. We had family medicine, pediatrics, and internal medicine present as attendings that worked with us, and an amazing group of 6, 4th year medical students. We all communicated well and were ready to work.
It was a somewhat slow morning, more so because we used interpreters for 80% of the patients. Thankfully, we saw almost whole families at a time. So, we divided and conquered. We ended up having a pediatric section, seeing most big families, an OB/Gyn section seeing female cases and a general area where other problems were targeted.
Between the cases we saw, there was one that struck me the most. A 29-year-old female with adult onset seizures was having at least 2 seizures a day because she reduced her medication due to lack of resources. There are things we could not completely fix, like this one, so we guided her to go the closest big hospital that offered care and free medications for her case. I was frustrated and powerless; however, I understand in our situation that, that was the most we could do.
After a full day of work, we all returned to our home and prepared for the next day. But, not before we discussed our day. I shared my successes and frustrations. Day 2 in the records.
This was our third day conducting clinics, but our second day at the same well-equipped clinic. There were more people than the day before, but we were prepared for this. We knew more people would be visiting since our patients from the day before had spread the word. We also knew that mid-morning would be slow, but after 2pm it would get busy as children got out from school and mothers were able to bring them.
This day we had some extra help from the clinic’s personnel; there was a licensed nurse who comes a few days a week to this clinic. We also had 5 Quiché interpreters, a much needed increase from the 2 we had the day before. Some of the most prevalent complaints that patients had were dry skin and scabies. We all learned how to recognize scabies very well and how to treat it in different ways. We learned to improvise as we did not have enough medication to treat every single person.
Being in new environments and trying new things began to take its toll. Some of the team members started to get sick with upper respiratory symptoms or gastric problems. Everyone did their best, regardless of not feeling well. We shared our best and worst moments just before sleeping.
At this stage in our trip, we were better organized and knew what to do in many common situations and presentations. Our leaders gave us feedback on the areas we had improved in. We felt more confident, even the ones that felt a little bit sick.
The location of this clinic was at a high altitude. As a result, we unexpectedly had a couple of team members down due to mild symptoms of altitude sickness. We were short staffed; however, we were able to divide the work efficiently. The community leaders were present at the clinic and helped us organize the rooms and most importantly, how patients were going to be seen. They told the community members we were going to be there by 8 and that we would see 1 person per family, however, we saw more than one when necessary and able.
This day ran a lot smoother than others, at least for me. This day I was doing triage. I saw every single patient who came to the clinic, got to briefly know them, and do a mental physical exam. One of the highlights of this day was the opportunity to educate people while they were in the waiting area triaging. I talked about water consumption, soda intake, the importance of a balanced diet and the importance of self-care. It seemed that in this community, everyone helped each other and had a good support system.
Even though this day was triage day for me, I was excited. I was able to give my input on patients’ presentations based on what I saw during my triage. One lady had spooned nails, she did not complain of it, but I believed it was something to note. I did not stop triaging people until around 11 am, one after the other. I was also able to see a couple of patients while my teammates were taking a lunch break. It was a great experience for me.
At the end of the day, we returned to the base clinic and prepared for another day. For the team members who were only able to stay with us for 1 week, this would be their last day. We learned to ration our items and we prepared everything so that we had enough to last until the end of the week.
San Juan Toleman is one of the bigger cities around Lake Atitlan with a population of at least a thousand people. Since the town was a bigger one, we expected more patients. The day started and we had a line of people out the front door. We had to limit our triage to about 100 people that day because after mid-day, 3 attendings were leaving with one medical student and a volunteer.
We were very efficient this day. We optimized time and resources during the morning. We finished the day very well; we saw everyone we triaged, and gave the necessary time to every patient and family.
One of the great successes of this day was when a classmate diagnosed a 6-year-old girl with a patent ductus arteriosus. She did not have any acute symptoms, but we were able to set up a follow up appointment with a cardiologist at the closest bigger hospital.
We finished the week, some of us tired, some of us sick, and a few already gone. But, we still got together at the end of the day to do an inventory of our items and to discuss what we experienced during this day and week. The week was over, and we were able to help many people in need of attention, and others that needed education.
We met with everyone Saturday night and debriefed the new team members. We not only re-stocked on medical items, but we recharged for another week. We slept more than 6 hours and ate more vegetables than we could have imagined. The street markets were filled with fresh vegetables and looked beautiful. Sunday came and we organized everything for the upcoming week.
The altitude of at least 5000 feet was going to be a challenge for everyone, as it was the week before. The team was already having some acclimation problems, and this place was one of the highest.
This was a place some of the team members were familiar with from the year before. We were excited that we were going to be able to see more people in need that otherwise would have waited another year for care.
The clinical work was a success. The usage of interpreters was beneficial again, however, we realized the interpreters were sometimes answering questions for patients without actually asking them the question.
The most memorable moment, was helping a little girl to see the ophthalmologist after 1 month of eye discharge due to corneal abrasion. The DOCARE team paid for her travel with donated funds and offered to pay for the visit to the ophthalmologist in the nearest big city, Sololá. The day had, again, been another success.
Many families were already gathered waiting for us when we arrived. The team was received with cries of “buenos días.” We had to go through about 90 to 100 patients in a day. The team knew we needed to focus, designate jobs, and start work.
We used some help from the community organizers to log patients; otherwise we would have been short in time and resources. We all did a great job managing the workload while taking staggered breaks. We went through all the patients we had. Here we had some help from interpreters as well. Most of the people spoke Kaqchikel, another dialect from the area.
Little by little we witnessed more patients coming to be seen, with more and more problems. The more we saw, the more we realized they did not have enough resources to do many basic things, such as showering or use soap. Hygiene education was one of the priorities for our clinical work in this community. We all knew this was going to be difficult since there were places with no running water. The clinic was one of the places without water access.
Many of the patients had complaints related to URI, conjunctival irritation and dust exposure, nothing unexpected due to the windy and dusty climate. Besides the dust related problems, this was scabies and lice day. We were able to help treat URI’s and scabies. However, nothing would assure us that once the families we saw left the clinic they would follow our directions of care. I know that I at least educated families about scabies hope that this initial intervention would prevent re-occurrences.
At this point, we were experts in building up a clinic and breaking it down. The logistics went smoother every day. We set up in a little house again, and people started arriving.
This was another dusty place, we saw many people with problems caused by dust exposure
and a dry environment. In addition, we saw many people that had work-related issues, such as carpal tunnel, and back pain. We had cases such as these at every site, and they were treated accordingly through osteopathic manipulative treatment. However, at this site we found a lot more patients with musculoskeletal complaints.
We arrived at the highest community of all. This area had in richness of views what it lacked in running water. The community members did not have houses; they had wood sticks supporting roofs made of cardboard. They slept on the floor and had no running water.
We were working from a school this day. Next to the school there was a giant tank that held the water for the community; this was the rain water supply storage. This community did not have water all year long, and it accumulated it using rainfall.
The clinic was set up quickly, we were expecting many people, however just a few showed up. Apparently, there were political parties visiting the community and the majority of people were there, and not coming to the clinic. Even though there were not many patients, the patients that we saw benefited a lot. We had interpreters, and they helped a lot with the few Kaqchikel speaking patients we had.
We also treated patient with a big abscess, he did not have systemic symptoms, but we know we got there just in time to prevent sepsis. Fewer patients were seen, but it was still a successful day in the highest place we were going to be.
One of the interpreters helped us the whole day. When we were able to attend to him at the end of the day, it was determined that he may have had a broken ulnar head. We helped with some immobilization and pain control. We were humbled by how much he helped us even though his arm was in a lot of pain.
We returned early to our home-based clinic located at an orphanage. There, we were able to do routine checks on the kids living there. We finished the day preparing for our last day.
Today, at least we had a short commute. After just 20 minutes on the road, we arrived at a school. The school was a little house with 2 rooms where kids of all ages received education. Sadly, we did not have much space and we had to accommodate kids in a different room. The teachers and community leaders were understanding and helped. There was a car with a loud speaker announcing our arrival to the whole community. However, this did not help much. The community was not big. The total 20 patients that we saw made up about 40% of the population in this community.
Patients here were all Spanish speakers, which helped a lot because we did not have interpreters. The patients we saw were assessed and treated. Due to a lower number of patients, we were able to spend more time with these patients than the patients we had seen throughout the entire trip. We finished mid-day.
We moved the clinic back to our home-base clinic. Here, we finished doing basic child checks for kids at the orphanage.
We started packing everything and organizing the clinic for the next group to come. At 5pm, Friday March 8h, 2019 we closed the doors of the clinic. At that moment we realized how thankful we were to have that place and to be able to reach many communities.
We met again at the end of the day to share our best memories and say our goodbyes. I am grateful to have met such a wonderful group of people who believe what we do is unique and worth every effort to help people in need.
I learned a lot and I grew as a person and as a future physician. Global health has always been my passion, and I finally can say that almost as a doctor in training I was able to help hundreds of people in need.
I am so grateful for this unique and empowering opportunity. Thanks you, DOCARE for helping me realize my dreams of participating in global outreach.
To help DOCARE do more work like this, please contribute here.
Bacteria: It’s the little things in life
Thanks to the generosity of Arizona Osteopathic Charities, in February 2019 DOCARE supported Stephanie Yanez (OMS I) to participate on a recent trip to Panimache Quinto, Guatemala under the supervision of DOCARE board member Kelli Glaser, DO. Stephanie kept a detailed account of her experience. See her blog post below.
When I started medical school, I had not been exposed to much in the field of public health. I wanted to be involved in a couple of clubs and asked around to see which would be best for me. A friend told me about DOCARE and how they focus on public health and community outreach. It was something new for me and I decided to join. I later learned about the Guatemala trip they would be doing later in the year and how they needed Spanish speakers for the trip. I thought this was the perfect opportunity for me to not only lend my Spanish fluency, but also participate in a project designed to evaluate the needs of an underserved community with the goal of ultimately improving their health. I joined the Guatemala planning committee and became involved with helping put together the educational resources we would be sharing.
The plan for the trip was to survey every household in the community in order to assess the community’s health and needs. We also had 4 educational classroom sessions planned on topics important for health. These 4 topics were: hand washing, water purification, dehydration, and teeth brushing. Besides these, we also planned on building several bunk beds which would be distributed to the households most in need. The plan was made, plane tickets were bought, and after several weeks of waiting, it was finally time to go to Guatemala!
We arrived at Panimache Quinto and introduced ourselves to the community leaders and translators. We went over the plan for the days we would be there and took a tour of the village. The village was small and the houses were often made of whatever material was available. There were lots of children playing near the school, and women washing clothes or making “huapiles,” the traditional woven clothing worn by the women in the community. Many women were carrying huge jugs of water up a very steep hill. Men weren’t seen much in the houses as most were working. After our tour, we started with our interviews and went around the houses to learn about their general health and to assess the community’s needs. The community was understandably shy at first, but after a bit of conversation, they were extremely warm. We finished our surveys of the day and then went on to the school to have our first educational classroom session. Day 1 was my group’s day to give a class on a health education topic and our topic was hand washing. We started by talking about what bacteria was and identifying bacteria as one of the causes of sickness. We shared information about how to properly wash our hands to kill bacteria and reduce the chances of getting sick. It was very nice to see the community members light up with understanding as to why washing hands is important. Both the children and adults were very interactive and we received several “eeehs” as confirmation for understanding. Before this education session, I was feeling a bit insecure as to what we were doing and whether we were actually making a difference in this community. But this educational session opened my eyes and made me see that what we were doing was significant, and that even something as little as teaching how to properly wash hands could reduce the spread of disease and prevent illness.
We continued our surveys on day 2 and learned more about the community as a whole. We saw a big difference between day 1 and day 2. The people of Panimache Quinto were much more comfortable around us and were sharing more information than the first day. We were even invited into people’s homes on several occasions. Even the children were coming up to us more and were more willing to have a conversation with us. The members of the community were also more open about telling us what their community needs the most. We made good progress on our surveys and then went on to the educational session of the day. The educational session for this day was water purification. We taught the importance of drinking clean water and methods of cleaning water. We tied this class to the previous class and talked about bacteria and how killing bacteria in water can decrease chances of getting sick. Most of the community seemed to already know that boiling water was important before drinking it, but they didn’t seem to know why it was important. It was very gratifying to see them connect the dots and understand that the reason they boil water before drinking it is to kill illness-causing bacteria.
On day 3, we were able to finish the rest of the surveys. On this day, I was able to help build the bunk beds and was very happy to see that two of the beds were going to be given to one of the families our group surveyed. The smiles on the family’s faces were hard to hide and you could feel the excitement radiate in their home. When we finished putting the beds together the family was extremely grateful, and the children were anxious to try them out. After we finished with the beds, we went over to the school for our last educational session. We shared information about how dehydration is caused by a lack of water consumption and can lead to headaches and dry skin. We also shared information about the importance of brushing teeth and how to do so properly. After this session and a couple of games with the children, it was time to say goodbye. We thanked the community for allowing us to visit their homes and for being so willing to answer our questions. We thanked them for participating in our educational sessions and said goodbye to everyone. As we were leaving, the children ran behind our van and waved goodbye.
Before going on this trip, I knew it was going to be life changing, but I didn’t anticipate for it to be this life changing. I was lucky enough to be in a team with leaders that prepared us for what we were going to see and who educated us on the importance of not feeling like we were going to “fix” this community. With this in mind, I was able to experience this trip through a clearer view and I was able to enjoy it without feeling too overwhelmed. This trip introduced me to what public health is and I now know I want to be more involved in it. Our school has another trip during 4th year to this same community and I will do everything in my power to attend. I want to thank DOCARE for giving me this grant and allowing me to experience this Guatemala trip. I will forever be grateful.
To help DOCARE do more work like this, please contribute here.
Pumpkins and Blueberry Muffins: Patient Care in Malawi
The following is a blog post that Dr. Donna Kaminski, MS, wrote while leading a DOCARE trip to rural Malawi in April and May 2017.
Our first mobile medical clinic day began wonderfully yesterday, when our team of seven volunteers arrived in Lilongwe and headed straight to the Crisis Nursery. T here, despite jet lag (and, for some, travelling close to one full day), our group began by sorting and preparing nearly 400 pounds of medicines we’d brought with them. We engaged in sweet conversations getting to know each other better while working for over four hours to prepare medications for our day in Katondo.
This morning, we slowly watched the feeding center become transformed into a clinic, complete with a vitals station, lab, pharmacy, office room, and patient sites. Patient after patient reflected a warm smile as they uttered zikomo kwambiri (thank you very much) in exchange for small packages containing medications that were in some cases as basic as Tylenol. Each patient had warmth, kindness, humility and gratitude that was heart-melting.
We welcomed over 400 patients. The large number was partially due a weather condition. Since December, heavy rains had made it impossible to get to the village to provide medications there. That means people came to us, happy of the opportunity to get the care they needed at last.
Among the day’s crowd was a patient I recognized well. During my last visit, I remembered her tears as she thanked me for seeing her, and then my surprise when she returned with a pumpkin she’d grown and close to three pounds of red beans she’d harvested. My eyes filled with tears as I knew that she gifted me with what was three weeks’ worth of food essential to her family. Today, she returned, and when I shared that I remembered her, her eyes filled with tears and we hugged. Much like the first time, she then returned with a pumpkin. Her gratitude was all-humbling for me. It made me realize that even larger than the gift of the pumpkin was the connection we shared, and how much it meant to both she and I.
Today was also filled with special moments. We watched a resident from my program, Brandis Belt, adjust her skillset to listen carefully to the patient, use her skills in touching and listening, and work out a diagnosis and treatment plan with nearly no lab tests. She used an important tool: compassion. As she spoke warmly with each patient, I could feel comfort and trust. It made me proud of her and made me appreciate the opportunity we had to share and create that space with each patient.
Lastly, we had two acutely ill patients who we found needed further treatment at the hospital. Fuel costs in the Katondo area approach $9-10 per gallon, which meant that patients who may earn $200 per year find that this expense alone makes access to the hospital impossible. So we chose as a team to assist these patients in going to the hospital. Without a seat to spare, we rearranged medication bins, squeezed together in the seats in any way we could, and created space for them. We drove with them the two and a half hours to the hospital. After we escorted them in, our nurse and coleader Mary Reagan ran out of the bus to give the patients the leftover muffins we had packed for a post-clinic snack, as food is not standardly provided to the patients in the hospital. As I looked out my window, I saw Mary giving one of the patients a hug.
It was a truly beautiful day. Our team of seven volunteers met just a day ago, but already we have bonded over the counting of medicines, provided care to 405 patients, and worked seamlessly and with a smile. And at the end of the day, as we drove home, saw this beautiful rainbow, which made me realize how perfect and special this day was.
And tomorrow our team of seven becomes ten, as three more volunteers arrive. We are very excited.
DOCARE sends abroad 15 trips like this one every year. If you’d like to help us bring more people essential care, please donate here.
“Señor, sus oídos se sienten mejor?”
The following reflection is from a student, Angela Niezgoda, who attended a trip to Tecpan, Guatemala, in February 2017 under the guidance of Dr. Gary Willyerd and Dr. Leonel Sacbaja.
The patient that made the most impact on me was an 85-year-old man named Juan. He had suffered two strokes that paralyzed him on the entire right side of his body. Everyone, including his wife, thought he had also lost his hearing due to the strokes.
During our patient work-up, I did a full-body examination. I provided osteopathic manipulative treatment to treat the cervical and thoracic dysfunction that had been plaguing him. However, upon closer examination of Juan’s ears, I noticed they were impacted with a lot of earwax. This was not a stroke-related issue, and we could solve it by irrigating both ears with water.
After the irrigation, I turned to Juan and said, “Señor, sus oídos se sienten mejor?” (Sir, do your ears feel better?) His face alone could have made anyone’s day or even their year. He smiled so big and said yes. It turned out that the strokes hadn’t had much impact on his hearing after all. His wife was amazed that something as simple as earwax had been the reason he was so unresponsive over the past few years.
It was an honor to serve not only Juan but his wife as well. It felt like I had given them a miracle. This put back into perspective why I want to do medicine, and reminded me of the feeling of compassion I get from it.
To help DOCARE do more work like this, please contribute here.
Midwives and Cycle Beads: Extending DOCARE’s Impact with Education
From the May 2017 DOCARE Newsletter
Can a string of beads keep a woman healthy? This February, fourth-year osteopathic medical student Carolyn Chatterton helped carry out a novel health education project aimed at helping Guatemalan midwives better serve women in their rural communities.
Chatterton, who attends ATSU-SOMA, traveled on a DOCARE short-term global health outreach trip to Sololá, Guatemala. (DOCARE Trip director Grace Stewart, DO, has led trips to the region for the past five years.) In the area, which abuts Lake Atitlan, Chatterton and classmates Rebecca Utterman and Casey Carney implemented a plan of action to train local midwives about aspects of the menstrual cycle.
“The whole concept was educating the educators,” Chatterton says. The group had devised an educational session in coordination with American midwife Susan Chasson, who has also traveled to Guatemala on separate occasions. The sessions they planned focused on sharing essential information intended to help midwives understand normal reproductive functions and symptoms of disorder.
In addition, the students gave the women with bracelets 32 beads in length. The “cycle beads” are meant to represent the days in a 28- to 32-day normal cycle, providing women with the means to count off days of fertility in a regular menstrual cycle. Chatterton acknowledges that the beads don’t offer the highest possible contraceptive efficacy, but rather are a way to promote birth control in a place where religious, social, political, and economic barriers can make other methods difficult to access.
While Chatterton herself was new to cycle beads—“I actually taught myself beading for this project,” she says—the group found that midwives “were completely familiar” with them. The “refresher” quality of the course didn’t distract from the purpose, however. Chatterton says that much of the point to the course was to pass scientific information from the English- and Spanish-speaking medical professionals to K’iche’ and Spanish-speaking midwives, assisting them to articulate medical concepts to the women in their communities.
Midwife Susan Chasson is returning in May to continue working with the local midwives, and while no strict timeline exists, Chatterton speaks of her work in February as a “pilot” for further education. She knows that midwives will likely be happy to return to these sessions. “I have found that, by and large, they are very interested” in sexual and reproductive health education, Chatterton says.
Would you like to help us educate more midwives? If so, please contribute.
"When we come to Kenya, we must learn both the culture and the medicine"
Julie Ronecker recently traveled with a group of clinicians to offer support to the Mama Pilista Health Centre in Masara, Western Kenya, under the supervision of former DOCARE President Gautam Desai, DO, and clinic founder Benson Bonyo, DO. Julie kept an extensive blog about her experience. See some highlights below.
The second patient on rounds was a young three-year old who was admitted overnight for malaria and UTI. After quinine, dextrose, ceftriaxone, and an overnight stay in the clinic, she appeared like a different child. For other communities, this child would have either had to commute 5-8 hours to a local hospital or wait out the infections at home. However, having the clinic in the local community allowed for rapid recovery and a discharge in less than 24 hours.
Part of being a good physician is learning about the area and being culturally-sensitive when providing medical care. For example, knowing that some members of the community believe in polygamy helps us test for multiple partners for sexually transmitted diseases instead of just one wife. Knowing that missing 6 bottom teeth in this village is culturally normal helps us not worry about vitamin C deficiency. Knowing that women carry large basins of water on their heads and babies on their backs gives insight into why joint pain, somatic spinal dysfunctions, and lumbar strains are common chief complaints. And, knowing that animals are sometimes sacrificed gives insight into potential exposure to blood-borne pathogens. On rotations in the United States we are familiar with the culture so the predominant goal of our clerkships is learning the medicine; however, when we come to Kenya, we must learn both the culture and the medicine as both are intrinsically linked in diagnosis, treatment, and management.
We were faced with a seizing one-year-old the moment we got to the clinic. The boy had been having a tonic clonic generalized seizure for over 45 minutes and was extremely ill. He was tested for malaria, which returned positive… Minutes of seizing turned into over an hour…. he was still breathing but remained rigid without pupillary or reflex responsiveness. Many times we experience pure hell as providers…