Hi Medical Staff,

What do we see there-lots of skin rashes, parasites, lice, PID, infections of every orifice and diarrhea from many causes. Complaints are of backaches, headaches, ear aches, sore throats, fevers and "nerves." Infected wounds, sores and some impetigo. Have had probably TB, malaria (less so where we go now-mountains). This last trip we had several babies that were severely dehydrated and ill, so we sent them (team leader provides $) or took them with a parent to a charity hospital that will take our referrals for hospitalization. Little to no Hypertension there. People have a much younger life expectancy-older people are rarely at our clinics. People look much older than they are, as well. Small  people, so children are older than you think. No sanitation so parasites re-infect them after we de-worm them, but it prevents the worms from killing the children. Sexually transmitted diseases are thought to be high in the population and there for if treating adult for any infection we give med that will take care of it and STD. We have found Children in need of cardiac surgery and we manage to get the surgery for them...through various means. We look at enhancing their quality of life and are generous with meds they might need as well as immediately need that day. Backaches and headaches are universal and when we rule out infections etc. we give ibuprofen or ASA, because the women carry large heavy baskets on their heads and the men often carry big bundles on their backs long distances. Often we see clogged ears, have pulled out bugs etc. from ears. Eyes are always red from fires in their homes and also the hot sun with no sunglasses-we give Klear eyes for relief. We give vitamins, soap, toothbrushes and we try to explain how to use and when to use . We use and teach the World Health Organization's Diarrhea formula to recover from diarrhea.

We never know exactly what we will see-one time our doctor lanced a tennis ball size abscess on a 2 yr old's forehead that had not infected her brain luckily. Another time we sutured a knife wound-think it was a machete accident in the fields...another time we found a woman carrying a dead fetus about 5 months along-sent and paid for her to have a D&C. We see about 4,000 patients in 5 days of clinics usually. We usually have 4 separate teams going out each day holding clinics in villages. The teams usually consist of 2 laypersons 2 interpreters 2 doctors and 1 or 2 nurse practitioners,2 pharmacy people and 2 or 3 nurses, sometimes a Priest or minister. Each team will vary a bit. The way we set up the clinic is to have an Intake area with a table and hopefully someone who can understand "some" Spanish and English will do an intake card on each patient and keep the families' cards together. The card is basic, but has the name and age and complaints and a place for the primary caregiver to write their findings and meds and treatments prescribed as well. After the intake the family sits in an area to see the primary care giver escorted by a lay person. Then when a primary care giver is free the family is escorted to the caregiver. The caregivers are seated near one another in a row and have something near them to put their equipment on and gloves are provided. I encourage you to bring lots of hand cleanser-some is provided, but we always run out. Bandages, alcohol etc. are provided and I always bring a bit, too. I bring stethoscope, otoscope and wish I had an ophthalmoscope, but those are suppose to be in each team bag now, but I will bring mine anyway. After the primary care givers treat the family and the cards go to the pharmacy to fill and then the family is seen in after-care by the nurses, who teach and explain the treatments, meds and or carry them out right there. After Care is very important to help the families to understand how to optimize their health and use the meds to help and not to hurt them! The primary care providers are seeing families in the open, but we set up a private room for examinations requiring privacy. I encourage all complicated patients to be seen by the doctors and any that seem less so to be seen by the nurse practitioners. That still means we sometimes consult back and forth about anything unusual. Sometimes the primary caregivers go on home visits with Elders of the church. Also, this depends on how busy the clinic is. We usually like to be back in the compound before dark to insure safety of all. We do not wonder off from the clinic alone and always check with the team leader before leaving. Generally we bring our own "lunches" crackers etc. Sometimes lunches are all taken together or a few at a time...

I apologize for rambling, but I have gone on this mission for the last 7 summers and it all does blends together. In a nutshell that is what we do. We try to share our blessings with others, but we receive so much more in the process. All who take this step of faith have returned richer and happier for the experience. I look forward to meeting you!!! Please don't hesitate to ask any questions at all. If you need more on any area-like what to bring...Bible and prayer book are great, as well as what you find you like and need in caring for clinic patients. We had an orthopedic Doctor who brought cortisone injections for knees and shoulders...was great for these hardworking people in such pain with frozen joints. Feel free to use your imagination to alleviate suffering-we are very open to new ideas... sometimes we pray over people, too.

Dios les bendiga! Melinda Hamilton

PS

Make sure your immunizations are up to date with Hep B and A ! 

Medicine Practiced From a Doctors Prospective:

Thank you for inquiring about my experience this summer as part of the Central Gulf Coast Episcopal Diocese Medical Mission to Guatemala. 

Although the five days of medical mission work was arduous, it was, indeed, rewarding for the providers and I believe for the patients as well.

Each day my team of providers (which include a nurse practitioner, a physician assistant, nurse, pharmacy, and interpreter support, as well as myself) saw approximately 200 patients at outlying clinics. These clinics varied from private homes to parish halls and municipal auditoriums.

We began each morning at 7:00 a.m. with a brief church service and, after breakfast, loaded our pharmaceutical supplies on buses and rode approximately 15 minutes to two hours to our outlying clinics. Upon arriving, we would split our responsibilities into patient intake, triage, medical management, and after care which includes instruction and eye wear. The mornings were very busy and we would take 15 to 30 minutes shifts for lunch (which we usually brought with us) and concluded in the afternoon at approximately 4:00 p.m. We reassembled our pharmaceutical supplies, reloaded them on the buses, and traveled back to the hotel. After dinner and comparing notes with the rest of the group, we restocked our pharmacy and headed out again the next day.

Most of the medical conditions we saw were minor such as asthma, abdominal pain ( most commonly related to worms or hyperacidity), back pain (related to the large loads they carry), and conjunctivitis (related to their Smokey and dusty environment). All were malnourished, had poor hygiene, and lacked good dental care. Several were sent for surgical care, primarily cataracts and hernias. We made several house calls. Some house calls were for complicated pregnancies and others were for medical conditions such as heart failure. A few people were sent to the hospital for medical reasons such as a child with severe pneumonia and dehydration.

Although this was a regarding experience, there were several limitations that impacted healthcare delivers. The most obvious was a restriction in pharmaceutical supplies, particularly advanced antibiotics. Although some were bought and some were donated, most were first-Iine antibiotics that were developed twenty to thirty years old. Additionally, we could not provide long-term pharmaceutical support, particularly in dealing with asthma or GI conditions such as ulcers. Also, we did very little surgical care, except treatment of minor skin lesions, there were no provision for advanced surgery.

Finally, as a pulmonary medicine sub-specialist treating primarily hospital-based patients or those with advanced lung disease, I was treating patients not usually matched to my medical training. Frequently, the nurse practitioners and physician assistants had more practical knowledge of illness such as skin rashes, wound care, and minor pediatric ailments. Some patients were referred to me who had congestive heart failure, advanced lung disease, or when the nurses were not sure of the significance of a heart murmur in pediatric patients.

Thank you.
Sincerely,
William E., Haik, M.D., F.C.C.P.