Back to The Past (March 2017) with las dos Elizabeths

Beth and Elizabeth do a great selfie

Recently I received some photos of the UTMB PA School March Rotation from Elizabeth Knipp, one of the students who participated in that expeience.  I immediately wanted to post them, because there’s several that are definitely worth sharing with the world.  But other chores got in the way, and a week went by, during which I got an email from a guy who was a very generous donor to the medication-and-supply fund for the last clinic.  He just wanted to remind me, it seems, that I haven’t posted anying in a while about the rotation (or anything else).  So again, I resolved to get something new posted soon … the next day?

That was about a week ago, or maybe a little more.  But again, other chores …. until this morning, which is much too rainy to consider working on the new patio I’m making.  I consider this great luck, actually, because I really need a break to rest my aching muscles, and the opportunity to finally catch up with some overdue posts (like this one) as well as some correpondence with a number of friends who must think I fell off the earth.

So now, with apologies and excuses out of the way, and with my public acknowledgement that if the road to hell is paved with good intentions I must be halfway there by now, what’s there to say about the rotation itself?

Well, the truth is that I would have to look back at my old emails and texts to remember what I heard and read at the time to write something detailed about this mission.  I wasn’t there, after all (unfortunately), to take photos and make my own observations.  But in a more general sense, I think it’s safe to say that in most respects it was a very positive experience for all concerned.  And my primary memory of the updates from the clinic, other than how nice Elizabeth and Beth were in their correspondences with me, was that while there were a lot of patients at the three separate clinic locations, it wasn’t as busy as some of the earlier rotations – including the one in February that I was fortunate enough to spend a week with.

That, in itself, is usually not a positive.  Of course, even when I’m fortunate enough to accompany the medical missions that I help prearrange, as a facilitator and not a practitioner I don’t have to put up with the stress of production line medicine, or the difficult triage and disappointment and occasionally even hard feelings when patients get turned away at lunch break or the end of the day.  If I did, perhaps I’d have a lot of appreciation for a few slower days mixed in with the busier. And perhaps it’s not having to tolerate the stresses of too many patients that allows me to feel, as I always do, that success at any of the medical missions I work with is largely defined by how many patients are treated.

So in that respect, this mission was not at successful as others, although in the end hundreds of patients were treated, and it was successful enough.

But at the same time I know there are other – and I think in the end more important – yardsticks of success.  Especially important, I think, in the context of an international rotation, is the extent to which participants have the opportunity and the privilege to experience an alien and exotic and in many respects beautiful Maya culture.  In that regard, all of the UTMB Rotations far surpass other, shorter, clinical experiences with which I’ve been involved.  I always hope the students appreciate that aspect of the rotations, particularly in those clinics conducted way out in the Maya hill country.  And in the vast majority of cases I think they have.

Also valuable to the students, meanwhile, is surely that the types of maladies treated in an undeveloped and extremely poor tropical country offer some number of new opportunities for learning.  I’ve heard from any number of practitioners of various sorts that in this respect the illnesses seen in Guatemala are frequently diseases of poverty, and similar in some ways to clinics that treat impoverished populations in the United States.  The difference is that in Guatemala the poverty is both deeper, in terms of the severity and percentage of desperately poor people, and broader, in terms of the abject lack of a safety net and resources, than what is found in the US or other developed countries.

At a deeper and more personal level, however, success is not just about how many people are treated or how much students learn about standard medical practice.  It is, rather, the degree to which mission participants return home more enlightened and conscious about the struggles of people who live in more desperate circumstances.  Again, I know that all of the students came away with increased awareness and, I hope, sensitivity in that regard.

But I think that for most students, the isolation of the clinics imparts perhaps the greatest challenge and lesson.  This is, in part, just a function of close, fairly sustained exposure to the grinding poverty in Guatemala’s rural areas.  But more than that, it is the lack of infrastructural support that characterizes the communities in which the clinics are held.  Their remoteness forces practitioners to exercise a level of independence, and in some cases improvisation, that is not required in many other professional settings.   There are no specialists down the street, after all, and x-rays or advanced imaging or even routine blood tests are either simply not available or are an unaffordable treatment luxury for many or most patients.

So mission participants are forced to make do with limited selections of drugs, and with little expectation that patients referred to the existing health system will be able to follow up with needed exams or further treatment.   Occasionally, this lack of access to treatment affects patients with acute illnesses.  But fortunately, medical missions and clinics, to include the UTMB PA rotations, usually have some of the most common medications for treatment of routine acute illnesses and minor injuries.   For that reason, the most gratifying cases seen by the team are those in which antibiotics or salves or nutrition supplements or anti-parisitics – or for the UTMB clinics, treatment of cervical lesions with cryogenic surgery – can solve the problem.

Very often, though, patients arrive at the clinics with chronic needs that short term medical missions are not able to address.  Such run of the mill chronic ailments as unmanaged hypertension and diabetes, for instance, or some persistent pain that could be something serious but needs diagnostic equipment beyond a stethoscope or otoscope, cannot be dealt with by transient medical practitioners except by referrals to existing – but likely distant or prohibitively expensive – medical providers.

This, too, is yet another point of similarity between the economically deprived rural populations of Guatemala and some populations, both urban and rural, in the United States.  And of course whether in the US or in one of the rural villages of Chichicastenango, free or very low-cost clinics can be so under-funded, under-equipped, understaffed, or poorly managed, or any combination of these, that they do not merit a large measure of trust.

In the case of short term medical missions in Guatemala, this lack of trust is reflected in the number of patients who come in for diagnosis and treatment from visiting “North American doctors,” because the local population presumes they know more, or sometimes more importantly, “have more,” i.e., some miracle medicine that will offer free and painless relief from their condition or illness.  Which is to say a significant number of patients arrive with unrealistically high expectations for technology and/or charity that can’t be met.

Learning to deal with such unfounded expectations of miracle cures and unlimited generosity, as well as with a resource-starved medical infrastructure, is perhaps a greatly underestimated lesson of medical missions.  But clearly, it is not the greatest lesson.  No, the greater lesson would be learning to have the patience and the depth of soul to look past whatever economic or social or cultural problems that impede the wellness of many patients, and to get past the annoying demands and irritating personalities of a few others, to the underlying humanity of all the patients who come to the rural clinics.

I’m happy to say that all the UTMB PA students with whom the Consultants for Community Development teams have worked thus far have shown a clear propensity for the kind of compassion that promotes good health on the part of the patient.  Beyond that, while I haven’t had the opportunity to meet all the UTMB students who have gone to Guatemala, all the reports I’ve received suggest that they were able to connect with patients at a level that allowed the students themselves to learn important cultural lessons as they gained experience treating diverse illnesses at the walk-in clinics.

As for Elizabeth and Beth specifically, judging from what others (their preceptor, the team of facilitators, and a few of their patients I know personally) say, they were outstanding not only in their ability to pass out the appropriate pills, but in their ability to interact with the people in a compassionate and authentic manner.

So my congratulations and heartfelt gratitude, Elizabeth and Beth, for your hard work and tolerance for discomfort.  Thank you!  And please know that should you like to come back for another round, we will certainly find a place for you on our team.

On top of the volcano