The clinic saw 688 patients in house and an additional 340 out of clinic in the campo. Some of our more seriously ill patients received blood transfusions, nebulizer treatments with steroids, potent IV antibiotics, cat scans, and transfers to Santa Cruz hospitals. We visited 6 remote communities up to two hours by car from the clinic on roads that cross rivers and often see only oxen and motorcycles--roads that could realistically only be traveled on by Land Cruisers with competent drivers. This was all made possible by the Loyola Stritch School of Medicine's trip down here, which brought with it a small part of the additional funding the clinic really needs.
Erin Feller examining a boy from Los Carbones
The Loyola team constituted 7 first year med students, 1 second year med student, 1 emergency medicine attending, 1 family practice attending, 1 pediatrics and internal medicine attending, and 1 urogynecologist attending, and 1 Jesuit chaplain. The med students were sprightly youngings who adapted well to the chaos that is developing world medicine and were well supported by amazingly talented attendings with venerable amounts of experience in the field.
Fording the river with suitcases of meds on the roof
The mobile teams were coordinated with government workers from a local hospital. The health apparatus in these areas consists of a number of health posts manned by nurses and the occasional doctor. Their charge is vaccination, primary care and referral, emergency medical aid, and public health campaigns. It is underfunded, underperforming, and of inconsistent penetrence, mostly due to geography and lack of oversight of the health workers. Some post we attended at were well-stocked, clean, and showed evidence of successful public health interventions in communities, while others laid fallow, more or less a guise of medical care with clear signs of rot. Some communities we visited were beyond the reach of a post; these were far and away the communities suffering most from preventable, treatable diseases.
Scabies with Impetigo of a 3 year old in Isama II
One such community was our first, Isama II, a recently founded community encroaching the boundaries of Parque Nacional Amboro, that was overrun with scabies, lice, pica (kids eating dirt because they lack vitamins), impetigo, and bichos, or intestinal parasites (I think I may have scabies, and I have already had to de-worm myself once this trip). We went through almost our entire supply of treatment courses for these our first day in the communities and had to purchase even more from our pharm supplier. The town's water supply was a river 50 m from the center of the town. A few households have a car battery that they will use to light their homes a night, but other than that the town remains pre-Edison. Lack of running, potable water is one of the main roots of their maladies, resulting in poor hygiene, higher rate of re-infection, and malnutrition.
View from the water tower in Cheyu during el Dia de Cheyu and a public health fair
The village of Cheyu, the following day, was a clarion call for the importance of public health. Just kilometers down the river from Isama II, Cheyu had a wind-mill pumped water tower, a few solar panels to light the town at night, a poured concrete school, soccer/basketball court, cafeteria, and, greatest of all, a well kept, well stocked health post with a heroically dedicated, compassionate nurse. Hygiene and nutritional-related health problems were scant in comparison to Isama II. While there was some lice, most of the people who presented to us with primary care issues. Going through patients, we caught a significant amount of cases that needed follow-up or immediate intervention. As a way of example, a pregnant woman came into the clinic who was past her due date and with breach presentation of the baby. Dr. Fitzgerald suggested she be transferred. Rapidingo, caballingo, we were able to have her transferred to a hospital for a caesarean. Another elderly woman presented with an advanced
pterygium, or wing-like growth on the white of her eye that can worsen vision. We gave her Lindsay Lohan-esque sun glasses and referred her to some Cuban ophtamologists in Yapacani.
A healthy Bolivian family that is particularly beautiful
Voluntourism, a portmanteau of the words "volunteer" and "tourism", is a term that came up often while Loyola was here. The term has been used to market volunteer vacations, but also frequently been used with a pejorative tint, especially when used in medical mission settings. There is a wide array of literature of the subject, including sharp critiques of the field and how it potentially damages local efforts in the same camp.
Children striking a brushing pose for camera after Dental Hygiene presentation by the students
One of the standard arguments here is that the transient trip from the States, which is vastly better funded and better equipped, erodes interest, funding, and utilization of indigenous efforts. Local efforts are dwarfed by the ostentatious, once-a-year trip made by foreigners, which in turn stymies the growth of the local, sustainable, and potentially more efficacious work done indigenously. This sort of thing has been documented by the VSO, though exhaustive studies of the effects these trips have are still waiting.
Dr. Mary Pat Fitzgerald, the trail-blazing Urogynecologist who has done fistula repair in Niger and is a personal heroine
I understand this argument, but it really lacks teeth until you start getting into the tailoring of a trip to the needs and wants of the volunteers, and not the host community. Then, the argument goes, there is a not-so-subtle shift from commitment to helping the members of the host community that transforms them into pawns in a pious, manicured celebration of charity. Any volunteer, like any person, has right to protect themselves from harm while on these trips. Almost equally, though, volunteers on these trips must recognize that, by coming, they are engaged to helping these host communities. Medical treatment of this kind, like human rights, are not simply like old clothes that you give to the poor. If you go on one of these trips, you better be committed.
Dr. Tracy with Alicia Stapleton and Matt Egan and a family from Isama II
There are, of course, critiques of these critiques, which basically take aim at the fact that, in the zero-sum game that is simply living a day to day existence, people receive care that would otherwise go without it. It's a hard argument to follow and in a brutal way it's true. But without structural changes, things will remain the same, and someone will always be bound to another's wanton charity. These seem to be the valences within this discussion, and it doesn't seem right to sit at either end of them, but to use them as tools to evaluate how to improve such and such a program.
Healthy Mom with a Healthy Kid with a Healthy Hairstyle
The most disturbing sentiment I heard from people down here was that the communities we treat were "not poor enough". I'll let that comment speak for itself. I guess it's just an expectation, but it still makes my stomach turn.
Lauren Valbracht, Coordinadora la Exploradora (Como Dora)
Weeks before the Loyola group was down here, it was el Dia de Palacios. A live band with cumbia played well into the madrugada.
¡Bailando Brah!
