Experiences in Delivering Care in a Third-World Country

It is hard to know where to begin. I'm currently in Tejutla, Guatemala on a surgery medical mission through HELPS, Int. I didn't know what to expect. Even though I have traveled in a number of third world countries in my life, I have never spent as much time in close contact as I have with the people of this beautiful country.

Guatemala is very mountainous due to its volcanic nature.  On the first day, we traveled to a remote village deep in the mountains at the end of a long dirt road. There are more than 100 people waiting for us at what is generously described as a community center. The folks live in small houses, many of which are concrete block or Adobe construction. They heat their houses with wood fires. Knowing this became important later in the day when it dawned on me that many of the patients' lung complaints came from their living conditions.

Our team included a physician, three PAs and a host of helpers and interpreters. We had basic medications and no diagnostics beyond pregnancy and urine tests. The complaints included a variety of somatic and GI complaints, including cough, "chest pain", and failure to eat and thrive. I saw many older adults who had spent their lives at high altitude and had never left the vicinity of their birth.

My first confrontation with the reality of life in this country in the rural areas was a 14-year-old girl who had a history of the TBI at seven years of age. She began having seizures and memory loss a year ago that were increasing in frequency. Her neuro exam was very focal with unsteady coordination tests. She had had imaging in San Marcos and a mass brain lesion was discovered. She needed to be referred to Guatemala City where there was a neurosurgeon who could deal with her mass lesion, but that care was far beyond the means of her family. They came to us for hope and all we could offer was prayer.

After a day of work on an endless line of patients and 160 exams, I felt like I had been in the country for a week. Their needs are overwhelming. A physician on our field team with a lot experience in this country helped me better connect with my patients. He told me to always ask where the patient lives and to ask how far that they traveled to see us. He said, "If a patient traveled 10 miles to see me, I try to give them 10 miles' of my time." Good advice.

My second confrontation with reality came on day two when we hiked to a village among the endless, cultivated, terraced cornfields to a church in the middle of a small mountain agrarian community. My patient came a short distance, complaining of headaches, and no appetite. It didn't take long to get to realize that she had an abusive, alcoholic spouse that made her life a living hell. With three kids at home and no resources and no escape, she had to endure her situation. I didn't have a pill or a cream that could ease her suffering. All that we could offer her was the prayers of the team and the encouragement to talk with the pastor of her congregation, the only resource that she had.

Each day, the street outside of our makeshift surgery and clinic is packed with a sea of humanity desperate for a little hope and possibly some healing from the physical pain and suffering in their lives. Our team's impossible job is to try to turn back this tide to a small degree with the finite resources we are able to transport to remove villages and towns, and cobble together locally. It is medicine and surgery at its most basic level.

I spent a significant amount of time in surgery, as the one of the few people on the team with reconstructive surgery experience. It was really hard for me to see consult after consult of people with significant disability from untreated burns, which we just didn't have the resources to deal with in a short 5 day surgery window. I am much more appreciative of how blessed we are in this country, and how we have eliminated the sorts of morbidity and mortality that the Guatemalan people live with each and every day.

I'm profoundly changed by this trip, and I have come to the conclusion that the reason that I like medicine and being a PA, is that I get so much more out of the relationship that I have with my patients, than the sometimes meager help that I give them.