Tuesday, September 4, 2007


Worms, Wilderness, and Wonders...
My Trip to Guyana

Why are you going to Africa?” I must have had this discussion 10 times with various friends, family, and colleagues. There are certain friends who, when they ask you to do something with them and say it will be fun, you tend to say yes and ask questions later.

“Hey, do you want to go to Guyana and see a ton of patients and help out the underserved?” “Yeah, sure Craig, who else is going?”

Guyana is in fact, in South America bordering Venezuela, Brazil, and Suriname. Lost yet? Ok, I admit I had to employ both Wikipedia and Google earth well after I had put in my schedule requests.

Performing “medical missionary work” or “international medicine” has always been a vague interest. In fact if you queried most medical students, I’d bet most of them would express some interest in the field. Many of my own emergency medicine residents have expressed a personal interest, and I typically steer them to Romania, with which our residency has a longstanding relationship through one of our gifted faculty members. I’ll always consider my month in Romania one of the most formative experiences of my medical career. It’s not until you practice medicine with limited or non existent resources that you truly understand pain and suffering. “We only have thiopental” as we discussed what agents to use to RSI the hemiplegic guy on his kitchen floor with a GCS lower than I’d have liked. A boy becomes a man, I often say.

We checked into JFK airport at 11pm after a quick Italian meal on the Lower East Side. There and at the airport we began to collect familiar faces, old Bellevue residents, cousins, whoever, mixed in with mostly new faces and our Guyanese “fixers.” We had all signed up for 10 days in Guyana and knew first thing in the morning we’d set up a clinic and go to work. First however, we had to get about 30 physicians, support staff, and a similar number of large blue suitcases on a plane, bound for Georgetown, the capital of Guyana. “Did you pack that bag yourself, what are the contents?” Thankfully I was never asked. What was in those suitcases? A quarter million dollars of medications that we would later distribute to 3400 patients over six days.

Guyana is the 2nd poorest country in the Western Hemisphere after Haiti. Georgetown, the capital, is not a particularly beautiful place. Apparently the interior is mostly rain forest, but we never made it there. Public health care is free, but there is a fair amount of corruption and some poor people simply cannot make it to see a physician. The ED is in the capital, the main public hospital for a country, did not have a functioning EKG machine the day we visited. After the British left the country in the 1960’s, the country suffered from the usual disastrous result of a party more inclined to hold power than help its people. There is no functioning railroad; it was sold piece by piece. There is no public transportation, minibuses rule the road, and watch out for cattle. Half the population is East Indian, the other half is African. In a span of 5 seconds, while traveling at a very high of speed, we almost ran over a cow, a sheep, a dog, and a child.

Our fixers run a group called Guyana Watch, which for 15 years has sponsored trips like ours, to go into villages and schools, see all comers, and distribute medication. Most commonly for hypertension, diabetes, and skin rashes. Along the way we encountered children with congenital heart abnormalities that were set up, through Guyana Watch, to be sent to India for corrective surgery.

Powerful stuff, to pluck a child from a village and later send him or her to India to for a lifesaving procedure. Guyana Watch Lottery.

I saw 102 patients one day. Yes I know because I counted. I collapsed afterwards. No, no one got intubated or a central line. We saw tons of “lotta” (tinea versicolor), “piles” (hemorrhoids), hypertension, and diabetes. Glucose of 375 with a pressure of 190/110 was the rule and for some reason the Guyanese refer to vitamins as “builders.” Brilliant. Seemingly everyone cut “cane” (sugar cane) and had low back pain. Prescribing Advil was actually a pleasure; these people had no money or access to medication and truly were appreciative of simple gestures.

Yet some people had just seen their doctors and just came to get free medicine. Others had no acute medical issues and came to “just get a checkup.” It’s an awkward feeling when you perform a service to individuals when you know they already have access to it through their government. It’s more awkward to spend a week working like a dog in 95 degree heat seeing patients, then discuss foreign policy with the President over cocktails.

The organizers of Guyana Watch were profoundly hospitable, we stayed in a nice hotel, and they constantly attended to our needs. They were also remarkably well connected politically. Half the time we were on the front page of the local newspaper, the rest of the time we had a big spread on the inside. A reporter traveled with us at all times. I rode in the back of a truck at 75 mph over bumpy roads; I thought I was going to die. I got cutaneous larva migrans in my feet from playing volleyball on the sand. We had fun.

At the end of our trip the President of Guyana, Bharrat Jagdeo, invited our group to his home for drinks. Discussing health care policy with a head of state over a beer was…I’m not sure how to express it - eye opening, illuminating, and heartbreaking. I think we all found him to be rather candid, not entirely dismissing our mission but putting it into the proper perspective with comments like “I met with a bunch of doctors last week who are doing the same things as you” and “you guys shouldn’t come only once a year, you need a more established, ongoing presence.” Fair enough. The Minister of Health also had some interesting thoughts about our goals… were we just stirring up the pot, leaving and letting the government clean up the mess?

Afterwards my colleagues and I had long conversations regarding the best way to help. Flying in unsupported to help out with Katrina. Working with an NGO in South America. Volunteering time in an ED in Romania.

Many of you probably have similar experiences. Many of you have made an impact. I wondered out loud if getting involved in the highest levels of government in a place like Guyana might be the most effective way to enact change. Certainly their training in Emergency Medicine has a long way to go based on what we saw in the public hospital.

Whenever someone says “I want to do international work”, I always ask them what they mean. Does it mean holding the hand of a poor child while you attend to her sick grandmother with diabetes? Does it mean attempting to influence health care policy on a national level? All those things I suppose, and many others as well. Just be sure to wear your seatbelt and plan on having those introspective moments where you wonder just what the hell you’ve gotten yourself into.

To learn more about international health opportunities click here

Chris McStay, MD is currently finishing up a string of nights, paying back shifts so he could go abroad. He took his dose of Ivermectin and is healing nicely thank you.

"PostScript" is a column designed to post moving, comedic, or interesting stories from anybody who works in or is a part of the health professions. All comments are welcomed.

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