Waiting for the Doctor
Part 1 of a continuing series
Read Part 2
In late February, for the first time, a medical team from Saint Peter’s University Hospital undertook a medical mission to the Diocese of Santa Rosa to see firsthand how the clinics the hospital had helped establish were functioning. Working side by side with the local physician and nurses who staff the clinics, they saw the gamut of health issues that affect those who live in poverty in the villages surrounding Chiquimulilla. While the mission was fraught with numerous challenges, there was no doubt about its rewards. Men, women and children with serious illnesses and conditions received treatment or referrals for specialized care. Possibly the greatest reward, however, was the knowledge that even after the team returned home, their work would continue — because a Global Solidarity Partnership is about a relationship, and this relationship, in many ways, has only just begun. Managing editor Kathleen Ogle traveled with the team.
When Bishop Paul G. Bootkoski led the first diocesan delegation — comprised of clergy, religious and lay representatives — to Guatemala in 2003, he witnessed firsthand the poverty of the people of Santa Rosa. With that visit, he committed the Diocese of Metuchen to a Global Solidarity Partnership with the Diocese of Santa Rosa.
But it was clear to everyone involved in that first delegation that the needs of the people of Santa Rosa far outweighed the resources of Catholic Relief Services Metuchen or Catholic Charities, Diocese of Metuchen. Further, the delegation returned home with a strong desire to ensure that all efforts would be directed toward making a real and lasting difference in the lives of the people.
Faced with these challenges, Bishop Bootkoski turned to Saint Peter’s University Hospital, the diocesan sponsored Catholic hospital in New Brunswick. The hospital’s Board of Directors not only responded, it responded generously. A team was recruited to explore ways the hospital could help and an annual budget of $100,000 was allocated for their work in Santa Rosa.
During the past four years, various delegations have traveled to and from Guatemala and Metuchen, and the relationship between the two dioceses has evolved. One of the fruits of the relationship is the establishment of five health clinics equipped with supplies from Saint Peter’s University Hospital.
By Kathleen Ogle
Managing Editor
CHIQUIMULILLA, Guatemala — On the last Sunday in February, a small medical team from Saint Peter’s University Hospital, New Brunswick, quietly arrived to provide a few days of medical care to the poorest of the poor in the villages surrounding this southern Guatemalan city.
On nearly every U.S. flight to this Central American country there is some type of evangelical missionary group on its way to build something or do some type of health care-related project.
Where such delegations and the team from Saint Peter’s part company is that rather than completing a week of service and returning home feeling good about what they may have accomplished, the Saint Peter’s effort is toward an entirely different end. Working with Catholic Relief Services Metuchen as part of a project called the Global Solidarity Partnership, Saint Peter’s is seeking nothing less than a complete transformation of the health care system in the Diocese of Santa Rosa.
They know it’s not going to happen in the few days they have to visit the five health clinics they helped establish one year ago in the villages of Santa Rosa. But these five health clinics serve about 5,000 people in 19 villages, and that’s a start.
“This is our first medical mission,” said Dr. Bipin Patel, chairman of Saint Peter’s Department of Pediatrics, setting the tone for the mission. “We will learn, they will learn, and next time will be better.”
In addition to Dr. Patel, the group from Saint Peter’s included Dr. Nayan Kothari, chairman of the Department of Medicine; Jacqueline Carey, director of nursing for the hospital emergency department; obstetrician/gynecologist Dr. Richard Lynen; pediatrics resident Dr. Sabah Kalyoussef; and internal medicine resident Dr. Mario Pereira.
Once in Santa Rosa the plan was for the Saint Peter’s group to meet with local physician Dr. Luis Hernandez, divide into three teams and staff the five clinics over the next three days.
Before they arrived though, they knew they would have to work through a number of challenges including administrative concerns about the project’s budget and an inadequate supply of medications. The local physician and his staff have been working within the structure of the local parish which coordinates social concerns ministry for the diocese. As a result, the doctor has been having a difficult time getting the resources he needs.
El Hawai
On Monday morning, Carlos, one of the local nurses, served as a driver for Dr. Kothari and Dr. Pereira who were assigned to the coastal clinic of El Hawai for the day.
On the way, he explained how Dr. Luis Hernandez and the nurses rely on the vigilantes — in Santa Rosa, vigilantes are community leaders — to let them know when people in the community are sick. When the pregnant women fail to show up for their appointments Carlos visits them at home to find out if something is wrong.
When the medical team arrived at the El Hawai Clinic, there were already a dozen people waiting to see the doctors. Over the course of the day, they treated 30 patients. One of the patients the doctors treated was an older woman complaining of stomach pain. The doctors suspected an ulcer, but there was no antacid to give her.
“This is what they’ve been trying to tell us,” Dr. Kothari said about the lack of medications. “It is good that we see it for ourselves. Decades of knowledge are useless when we can’t give them a pill.”
One worried young woman — who had not eaten in three days and whose period was three weeks late — thought she may be pregnant. The clinic did not have any pregnancy tests so she was referred to a private doctor.
The mother of a 16-year-old girl, who was diagnosed with epilepsy at age 10, came to the clinic to discuss medication. Her daughter’s epilepsy was controlled with 500 mg of valproic acid taken twice a day. However, the woman could only afford one 500-mg pill per day. Without the second dose, the girl experiences three seizures each week.
An elderly man, completely blind from glaucoma, came to the clinic because he was itching for more than a month. Dr. Pereira’s diagnosis was scabies.
“The problem is we have no way to confirm any of this; it’s hearsay. This is all empirical. There’s no way to prove it. We use our clinical judgment which may or may not be incorrect in a situation like this,” Dr. Kothari said.
Despite the lack of diagnostic equipment, Dr. Kothari believes that he and Dr. Pereira were correct in the care they were able to provide “It was not fine-tuned like we were at home, we didn’t have CAT scans and MRIs and all that, but that shows you how little you need to really treat people,” he said.
One thing Dr. Kothari said he would bring back with him from the mission was a better appreciation of the resources available at Saint Peter’s.
While overwhelmed at the conditions, he was not discouraged. “If we make a few changes we can do a lot. I had assumed that since this was our third visit and we discussed all these things, things would be there automatically. But it all can be fixed,” he said.
Dr. Kothari sees the hospital’s work in Guatemala as an extension of its mission in New Brunswick and he would like to see Saint Peter’s residents and faculty spend a month living among the people in Santa Rosa and working with the local doctors.
For residents to participate, Dr. Kothari insists that they speak Spanish. “That is essential,” he said. Although he, Carey and Dr. Patel began taking Spanish classes, all three have experienced difficulties learning a new language while maintaining demanding work schedules.
He said the Saint Peter’s team is looking forward to bringing other medical specialties — particularly surgery and ophthalmology — to Santa Rosa, but the goal is to have the local medical team meet the day-to-day health care needs of the people.
“Unless you create a self-sufficient organization here it cannot work. We can support, we can assist, we can come here; but ultimately they need to learn how to do it,” Dr. Kothari said.
San Antonitos
On Tuesday, Dr. Lynen and Carey traveled to San Antonitos. While the Santa Rosa mission is Dr. Lynen’s first, Carey has participated in 30 missions — some surgical missions, such as Operation Smile and Healing the Children, as well as relief efforts following the Tsunami in the Southeast Pacific and the Gulf Coast hurricanes — over the course of 30 years.
The difference between those medical missions and the Santa Rosa partnership, Carey explained, is that in relief work, the medical team comes in, works until the emergency is over and then leaves. With the surgical missions, the team goes in, does their surgeries and then leaves.
“When a medical team visits an underserved area a tremendous amount of planning and preparation is necessary to make the best use of the medical team’s most important resource — time. Community leaders inform the people that a physician will be at the clinic. The medical team’s time must be scheduled in advance,” Carey explained.
“This kind of work is really different from anything I’ve ever done, but it’s good because you don’t just fly in, do something and leave. You come back and you work with the people.
“We’ve been here working for two years and hopefully we’ll continue on. We’re serving the needs of the people but we depend on the people who are here.”
When Saint Peter’s invited Dr. Lynen to participate in the medical mission, he immediately said yes.
“I had heard about the project before, and realized that I might be an asset. I’m fluent in Spanish and in a specialty that hasn’t come here yet,” he said.
At the San Antonitos Clinic, Dr. Lynen saw 27 women, ages 15 to 76. Asked if he had the equipment that he needed, Dr. Lynen responded, “There’s really essentially nothing except the handfuls of drugs, which we brought. We used a stretcher as an exam table, which suffices of course, but it’s not adequate to do a real gynecologic examination without stirrups or specula.”
Despite the limitations, Dr. Lynen said he was encouraged by the Saint Peter’s commitment to help. The mission also made him realize how much he takes for granted back in the United States.
At Saint Peter’s, Dr. Lynen’s role is to care for indigent patients at the hospital’s maternity clinic and to supervise and train residents.
“In the U.S., our indigent patients have limited resources but they are far better off than the patients here,” he said. “These people are scratching at bare minimum. You see over here the kids are barefoot, the houses don’t have electricity. It’s a world of difference. We didn’t even have electricity here in the health clinic. We had running water today in the clinic but then it stopped.
“I expected to find conditions along these lines but not as severe. I certainly thought that we would come and there wouldn’t be everything but I didn’t realize there would be so little.”
He still feels the mission was worth it if it leads to the correct measures being taken to address and correct it.
“We helped the people here today which is great, but it has to be sustaining. We have to put the mechanisms, processes and resources in place so that it can become a sustained process.”
Addressing the issues
That evening the Saint Peter’s team met up with CRS Metuchen director Father Joseph J. Kerrigan and CRS Metuchen volunteer Ernest C. Revoir. The next morning, Father Kerrigan, Revoir and Carey — with Lane Bunkers from CRS Guatemala serving as translator — were scheduled to meet with Father Monterosso and his administrative team to work through the issues impacting the functioning of the clinics.
“This is how it’s different from Habitat for Humanity and even some of the other medical missions,” Father Kerrigan explained. “In a sense, that’s the easy stuff, where you bring everything, do it all yourself, go home and feel good. Here it’s a little messier, but in the long run it will be more transformative.”
Dr. Kothari agreed. “I think it can work very well. All the ingredients are here,” he said.
“And the model we chose fits into their own health system, the outpost system. It’ll work, we’ll get it straightened out,” Revoir said.
Oliveras
In the morning, Dr. Patel, Dr. Kalyoussef and CRS Metuchen volunteer Hector Escobar were assigned to the Oliveras Health Clinic where they saw 60 children. Escobar translated for Dr. Patel and Dr. Kalyoussef.
Dr. Patel, a veteran of many medical missions, said his own expectations of the mission were modest and he was also optimistic about the medical mission’s accomplishments.
“We’re here for one day; we’re not going to change the entire community, we’re not going to change the entire health care structure in one day,” he said. He believes that the mission also serves as an important symbolic gesture. “We physicians are working with the medical team. If we are here and see what is happening, we may be able to help them with something. If we try to replicate what we work with at home, it will be a failure from day one,” he said.
“I expected we would find out how the team is functioning because we got to work with them. We would know their skill sets and their limitations. We also saw signs that there were some internal issues that needed to be addressed, but I’m sure we can work those things out.”
Dr. Patel emphasized the need for systemic change in Santa Rosa. Toward that end, the Saint Peter’s team has applied to the United States’ Agency for International Development for a grant. In short, the program is an alliance between a private institution and public agency. For every $2 that Saint Peter’s contributes in financial resources and in-kind donations, the USAID matches with $1. The major purpose of the grant is a focus on women and children to decrease the mortality of infants, neonates and women.
*The attached/referenced article was originally published in The Catholic Spirit, the official newspaper of the Diocese of Metuchen, and is protected under U.S. and international copyright law