I quickly finished my day’s work in the resident’s clinic (documentations, relaying results) and raced home to hurriedly double check the list of things that I would need for my week long medical mission in Roatán, Honduras.
The air was frigid, and my pace matched the wind. In the 2-hour car ride to the airport, my mind was alive and restless; making mental note after mental note about our endeavor but most of all there was an excitement that reverberated with expectations and imaginations of practicing a novel form of medicine, and of course, bettering lives. Ever since medical school, there is a sense of altruism that every doctor nurtures. To me, serving an underserved population in the most rural parts of a developing nation fulfilled that in the most complex and complete way. Although, in all honesty, apart from my genuine enthusiasm, three years of training in a model American health care system and a few hours of tropical medicine readings, I did not board the plane with an in-depth knowledge or experience on how to practice third world medicine. With intermixed feelings of doubt and anticipation, I placed my trust in my mentors who had successfully participated in 10 such medical missions. “They lead, and I follow, they instruct, and I perform,” I reassured myself.
We filled the next few days with avid preparation, in the backdrop of riveting views of crystal waters, and deep blue skies. The following day, the medical team along with the pharmacy volunteers, a physical therapist, an RN and other helping hands piled into a bus. We were to participate in brigades each day at separate rural locations. Something was different about our team from America; our brisk walk had slowed to a leisure as it did not seem to match the pace of “island time.” We had stepped out of our usual system of defined roles and lent a hand in any way we could, slipping into our temporary roles with versatility and self-proclaimed responsibility. We were not functioning seamlessly by any means, however, overtime, we were able to perform our routine much more efficiently.
A routine which involved scoping out our environment (usually a church or a classroom), quickly assessing and improvising to create a make-shift clinic equipped with a triage area and pharmacy. A typical day involved seeing 140 to 160 patients between us 5 doctors. Each encounter was strange, creative, challenging, beautiful and educating. We saw them in pairs and with their families and their neighbors; each narrating a story about their neglected health. Frustration quickly sets in amidst helplessness when you see a tender 18 year old with a complex social history suffering from debilitating panic attacks or a 70-year-old grandmother with all the tell-tale signs of poorly controlled diabetes, who must care for her 2 granddaughters. Sweat trickled down our faces, I thought it symbolic of our efficiency. Despite the humidity and a growing crowd, there was an ease with which we operated, as if reunited with “old world medicine.” As we, the doctors broke free from lengthy documentations and the loom of litigation, our patients also seemed to recognize something new: compassion.
In order to help the people of Roatán, we must first define the ‘help’ that they need, then identify the culprits and impedances and in turn strategize potential solutions. Health illiteracy, lack of regular medical care, lack of resources and financial burdens contribute significantly to poor health care. I cringed whenever I heard comments like, “You guys are amazing, what you are doing is saving lives.”
Why did these comments make me feel so uncomfortable? Was it because I felt like I was lacking humility if I acknowledged them or was it because, I asked myself, “Are we truly helping?” Medical brigades have been the pattern of most missionaries venturing into resourceless countries, however recently there has been much inspection and analysis regarding the goals, effectiveness and even possible harm with conducting such missions. From my own experience, I have come to a realization that we have to be careful not to be careless. We must be cautious not to instill a detrimental culture, one which indirectly supports false notions. One cannot help but ponder whether such brigades reinforce ideas such as “there is a pill for every disease” or “the American doctors have a cure for my ailment.” More dangerously, are we inadvertently downplaying the seriousness of chronic medical illnesses (HTN, diabetes) to the people of Roatán by relaying that these conditions are manageable with once a year evaluations by foreign doctors with free pills and a complimentary toothbrush?
Public health seminars and health education classes are being initiated for the general public on prevalent topics such as diabetes, hypertension, family planning and personal hygiene by new local physicians. Our help would be most useful if we collaborated with local physicians in the birthing of such programs and extended our expertise to nurture them into successful operations. There are medical clinics scattered throughout the island, therefore access to medical care is available however is often limited by financial constraints and lack of transportation. With regard to the issue of access, brigades have their own advantages.
How can we get the best out of the brigades? After a brainstorming session, we devised some ways to counteract the issues: 1) We handed out limited supplies of medications which will force follow-up; 2) We partnered with a local clinic for referrals and follow-ups, educated patients about the same; and, 3) We dedicated a booth at the brigade to schedule an appointment (for those who required it) at the clinic, prior to the patient leaving. Secondary issues such as transportation was arranged with local churches. With this, we hope to initiate a culture change. A chance at revamping health care in these parts of the world will be most successful in terms of sustainability and overall long-term health only if we incorporate and collaborate with local clinics to bring structure to what is already in place. In essence, we patch the holes of a broken health care system rather than construct an entire, new system.
As we debriefed under the setting sun, we were all united on one thing: Our reignited passion and longing for the undiluted practice of medicine. Although we packed our bags reluctantly, there was a new found determination in our hearts to re-instill the power to this dynamic community who welcomed us with an overwhelming amount of gratitude and sent us home with a revitalized spirit.
Apoorva Jayarangaiah is a hospitalist.