Helping others to the best of your abilities

At some point in our lives, I believe we all think about the bigger picture. We get out of ourselves and consider how we can help this world become a bit better, improving the world by helping in whatever way we each can. There are many ways of doing this: some people give money to a worthy cause, some people volunteer their time towards something that could make a difference and still others implement small changes into their daily lives that, in the long run, add up to a big impact. Still others, do all of these!

As a physician, it is pretty easy to find an organization to which I can donate my medical knowledge. It isn’t always so easy to find the time with limited vacation, family and work demands. Periodically though, the stars line up. Then, I am able to get out there, improving the world by volunteering.

Arriving at Abancay, Peru

What did I do? How did I try improving the world by volunteering? A few weeks ago, I had the privilege of traveling to the town of Abancay, Peru. The trip was to help out in a medical mission at the regional hospital. Although the town is pretty developed, getting there was difficult because it is located in between mountains. So, we flew into the gorgeous city of Cusco. Then, we took a car ride close to 4 hours up and down topsy-turvy mountains. The views were absolutely breathtaking! Although at the end of the end of the 4 hours I had feared for my life more than once and my stomach was not feeling so hot 🤢.

We stayed at the traditional Hotel Touristas along with the rest of the group from PAMS (Peruvian American Medical Society). The accommodations were simple, yet clean and comfortable. Most importantly, it was within walking distance of the Hospital Regional Guillermo Diaz de La Vega. We had an amazing group of about 30 volunteers improving the world by helping Peru: from physicians, nurses, pharmacists and translators (my husband was one of those 😍).

Heading to work

Our first day started with a beautiful walk to the hospital. We were surrounded by the Andes mountaintops and clouds, which sure beat my usual NYC “concrete” commute. When I walked into the waiting room, it was packed with patients. Many women dressed in the traditional garb used in the mountain region, with colorful skirts and warm sweaters. Many had a baby in tow, wrapped up in a vibrant blanket and carried on their backs. Their cheeks were pink from the cold and the altitude. Their hands, thick with callouses from working the land. I noticed a very particular smell in the air. It wasn’t a bad smell. It was more of a gamey, earthy smell that permeated everywhere people collected. I later found out that many of these people lived in remote, sparsely populated communities. They would walk 8-10 hours, sometimes more, just to come and see a doctor.

Whenever these medical missions are coming to town, the word spreads quickly. Sometimes by word of mouth, but also by the local radio, by flyers and drivers. Shelter-like spaces are set up to accommodate the people as they trickle down the mountain to see a subspecialist service that they normally don’t have available.

During my time there, many mothers came with their babies who had been born with cleft lip and/or palate and needed them repaired. We also saw countless others (adults and kids) who needed neurologists, rheumatologists, infectious diseases specialists, pulmonologists and so on.

These medical missions always leave me with mixed feelings. You see, we help out and initiate treatments for many, but who will follow up these patients? The local doctors have to become jack of all trades and they truly do the best they can with the resources they have. However, they often times don’t have the expertise needed, because that takes years of separate training. Other times, it is frustrating because the patients truly can’t afford the treatment they need, even with the medical insurance provided by the government.

The case of the teen

One example that comes to mind: we met a 17 y/o previously diagnosed with a terrible autoimmune condition called rheumatoid arthritis. This is an extremely debilitating and progressive illness which can be controlled with the right, daily, lifelong medication. This boy’s mother was working hard to put him through university and get him an education. The cost of his daily medication was more than what his mother made and, to further complicate matters, the closest rheumatologist was 4 hours away in Cusco. This was the only rheumatologist available there, so as you can imagine, getting an appointment was no easy feat. How does one deal with this situation?

The case of the child

Another mother brought her five-year-old son in tow, carrying him on her back, as they carry the babies, because he could not walk. He was severely delayed and did not talk either. He could barely sit unsupported. The mother thought this had all started a year ago after he fell. However, something didn’t make sense.

So, we took him to see the visiting neurologist, Quechua (local Incan dialect spoken by many in the region) translator with us, and started reviewing his medical chart. It appeared he had been to the hospital a few times over the last few years with complaints of seizures. He had never spoken. After talking for a while, the mother told us in her native Quechua that her husband had beaten her so badly while she was pregnant with this boy, that she often worried he would be hurt.

It appeared that the baby was born with brain injury from lack of oxygen at some point. It is hard to know when the injury happened, but pretty sure her beatings didn’t help. Unfortunately, domestic/physical abuse is rampant in the countryside. The boy had been seizing for years, further complicating his development and causing more brain injury. The neurologist started anti-epileptic medications and gave the mother some lab slips to have medication levels checked, in an effort to control the seizures and ensure safe drug levels.

Unfortunately, there is no pediatric neurologist there, so he will have to be followed by a general pediatrician who is not trained in this. However, they will have to make due. It is asking a lot for a generalist to manage this, here in the US the pediatrician would refer to the neurologist. It is not surprising that the child was not on any seizure medication, because it is not in the typical pediatrician’s scope of practice.

The good and the bad

Of course, they weren’t all sad stories. Over 16 kids had their clefts repaired. We also stabilized a little 1 year old girl who presented with extreme dehydration and in shock. It was a great opportunity to borrow the adult ICU’s ultrasound machine and teach the local physicians how to put a central venous line via ultrasound to secure venous access in this little girl. That way, she could be safely transported to Cuzco to receive care by a pediatric surgeon, which was not available in Abancay. This girl had a successful transport and was able to have surgery for her intestinal obstruction.

I think these stories make it easy to see how these visits are bittersweet. You think “I’m improving the world by helping out”, but you come, you help those you can, and then you have to leave again, when there is still so much to be done. However, I take comfort in the knowledge that maybe, I caused a tiny little dent in the system. Slowly, together, as more missions come and the local systems improve, we can chip away and help meet the medical needs of everyone. Then, perhaps, we can improve the lives of others and make this world a little better. I invite you to find something that matters to you and find out how you can make a difference in that area.

Happy investigating!